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"^Illinois 
3wl Medical 
ournal 


July 1974 Volume 146 No. 1 



Health scien 
universi 


JUL 3 1 74‘ 


A RYLWo 
ORE 


REC'D 


CIRCULa, 


IAL JOURNAL OF THE 
IS STATE MEDICAL SOCIETY 


Our 75th Year 


JETD. JAN 2 5 


•art 



President’s page. ...12 


HEALTH SCIENCES LIBRARY 

UNIVERS,TY OF MARYLAN0 
BALTIMORE 



When parenteral analgesia 
is no longer required, 
Empirin Compound with 
Codeine usually provides the 
relief needed. 



Empirin Compound with 
Codeine is effective for 
visceral as well as soft tissue 
pain— provides an antitussive 
bonus in addition to its 
prompt, predictable 
analgesia. 


€ prescribing convenience: 

up to 5 refills in 6 months, 
at your discretion (unless 
restricted by state law) ; by 
telephone order in many states. 


Empirin Compound with 
Codeine No. 3, codeine 
phosphate* 32.4 mg. (gr. V 2 ); 
No. 4, codeine phosphate* 
64.8 mg. (gr. 1). ^Warning- 
may be habit-forming. Each 
tablet also contains.- aspirin 
gr. 3V2, phenacetin gr. 2 V 2 , 
caffeine gr. V 2 . 



& 

Wellcome 


Burroughs Wellcome Co. 

Research Triangle Park 
North Carolina 27709 



Healing nicely, 
but it still 

HURTS 


EMPIRIN 


COMPOUN 

C CODEIN 

#3, codeine phosphate* (32.4 mg.) gr. Vz\ 
#4, codeine phosphate* (64.8 mg.) gr. 1 






New Medical Trustees Elected to 
Board of Illinois Medical Service 

Five medical trustees, including two new mem- 
bers, were elected to the Board of Trustees of Illi- 
nois Medical Service at the annual meeting held 
June 11 at Blue Cross and Blue Shield headquarters 
in Chicago. Medical trustees reelected to new terms 
of office were: Dr. Joseph R. Mallory, Mattoon; Dr. 

V. P. Siegel, East St. Louis; and Dr. Leo P. A. 
Sweeney, Chicago. The new medical trustees are 
Dr. George Shimkus of Aurora, and Dr. Thomas 

W. Samuels, Jr., Decatur. 

Dr. Shimkus is board certified in obstetrics and 
gynecology, his full time specialty. He is a member 
of the senior staffs of St. Joseph Mercy Hospital 
and Copley Hospital in Aurora. A member of the 
American College of Obstetricians and Gynecolo- 
gists and the American Medical Association, he is 
a delegate to the Illinois State Medical Society 
from Kane County. 

Dr. Thomas W. Samuels, Jr. is a general surgeon, 
board certified and in solo practice. He is a staff 


member of both Decatur-Macon Hospital and St. 
Mary’s Hospital in Decatur and President of the 
medical staff of Decatur Memorial Hospital. Dr. 
Samuels is also a member of the American College 
of Surgeons and American Medical Association. 

Medical trustees in addition to the new mem- 
bers and those reelected are: Dr. H. Close Hessel- 
tine, Chicago; Dr. Franz Steinitz, Chicago; Dr. 
William De Hollander, Springfield; Dr. Alexander 
Ruggie, Skokie; and Dr. Robert Stepto, Chicago. 

Ten medical trustees and nine public trustees 
serve on the Blue Shield Board. Public trustees 
include: Henry B. Anderson, Chicago; Howard 
Builta, Minonk; Dr. Frederick L. Eihl, Moline; 
Dr. O. Kenneth Johnson, Chicago; Emil J. Koe, 
Park Ridge; George E. Tapling, Chicago; Robert 
Agnes, Bensenville; Weir C. Swanson, Arlington 
Heights; and Mathew P. Cicero, Rockford. 

Officers of the corporation are: Dr. H. Close 
Hesseltine, Chairman of the Board; Dr. V. P. 
Siegel, Vice Chairman; Mr. Robert M. Redinger, 
President; Dr. Alexander Ruggie, Secretary; and 
Mr. George E. Tapling, Treasurer. 


! ! 











Highlights of Annual Report .... 

Record Levels of Corporate Operations., 
Service Improvements for ’74 Emphasized 

Record operating levels were achieved by the 
Illinois Blue Cross and Blue Shield Plans in 1973, 
Robert M. Redinger, Chief Executive Officer, stated 
in his message in the 1973 annual corporate report 
published recently. Commenting on operations, he 
noted that approximately 4 U million claims were 
paid by the Plans under both private and govern- 
ment programs during the year, representing an 11 
percent increase over 1972, with the total dollar 
volume of business approaching $1 billion. 

Other highlights of operations and programs 
cited were: 

( 1 ) Membership in the Illinois Blue Cross Plan 
reached a total of 3.2 million persons in 1973, and 
Blue Shield membership increased 9 percent to a 
high of 2.9 million. 


(2) Programs in which the Plans are primarily 
involved in the health care delivery field include: 
Containment of health care costs; development of 
Health Maintenance Organizations; introduction of 
new coverages; cooperation with consumer interests 
and community affairs. 

(3) Because of the tremendous growth in the 
number of insured persons and the changes occur- 
ring in health care delivery in the past few years, 
considerable stress has been placed on the Plan’s 
internal operations that require attention. Service 
improvement is, therefore, the number one objec- 
tive of both corporations in 1974. 

“By determining where service improvements 
are needed and how these improvements can best 
be achieved, we can assure our members of pro- 
gress in this area in 1974”, Mr. Redinger emphasized. 


(This report is a service to the physicians of Illinois) 


ASK BLUE SHIELD . . . ABOUT MEDICARE 


ACCEPTING ASSIGNMENT OF 
MEDICARE BENEFITS 

When a physician and his patient agree to the 
assignment method of billing for Medicare services, 
the patient conveys his right to payment of benefits 
to the physician. Under the assignment of benefits 
the physician agrees to accept the reasonable 
charge as determined by Part B Medicare as pay- 
ment in full for services or items he furnishes, and 
that he will not bill the patient for any charges 
disallowed as “more than the allowable charge”. 

The patient is responsible for 20% of the allowable 
charges (20% coinsurance), any amount applied to 
the Part B deductible, and any charge for services 
disallowed as non-covered. The Part B carrier will 
pay 80% of the reasonable charge over and above 
the $60 deductible. 

Each year a new Part B deductible must be met 
by the patient. Effective January 1, 1973 the 
amount of the deductible was increased to $60. 
Even though a person is not eligible for Medicare 
for the entire year, the full deductible must be met. 
A “carry-over” provision in the regulations, how- 
ever, applies to covered expenses incurred in the 
months of October, November and December. Any 
covered expenses incurred in those months which 
are applied to the deductible for that year will 
also be applied toward the deductible for the 
following year. 

If a patient, for example, had no medical ex- 
penses for the year 1973 until the month of October 
and then incurred covered expenses of $60 during 
the next three months, these expenses will satisfy 
the deductible for 1973 and 1974. As another ex- 
ample, a patient may incur expenses of $20 prior 
to October and another $40 in November and 
December. The $40 will be applied toward the 
1974 deductible, as well as the remaining 1973 
deductible. 

The “carry-over” rule was established to help 
the beneficiary who might otherwise have to meet 
the entire deductible twice in a comparatively 
short period of time. 

Before payment can be made, the claim form, 
SSA 1490, Request for Medicare Payment must be 
completed, including the signature of the patient 
and the physician on every assignment claim. 
Item #12 on the claim form (Assignment of patient’s 
bill) must show whether the physician and patient 
agreed to the assignment. The box “I accept as- 
signment” must be checked, otherwise payment 
will be made to the patient. 

The patient’s signature must appear on the SSA 
1490 Request for Medicare Payment form except 
under the following circumstances: 


(1) When the patient is a Public Aid recipient 
he is not required to sign the form. The Public Aid 
number of the patient is noted on line 5, and on 
the patient’s signature line the wording “Public 
Aid Patient” is either stamped or written by the 
physician or his office assistant. 

(2) When a patient is unable to sign the claim 
form because of a mental or physical condition, 
the patient’s name is shown on line 6 of the form, 
followed by the word “by” and the signature and 
address of the relative or approved representative 
explaining his relationship to the patient. A state- 
ment is also needed explaining why the patient 
was unable to sign the request. 

(3) If a person cannot write his name, he may 
sign with the mark (X) on the signature line, 
but the name and address of a witness must also 
appear on the line. 

( 4 ) When a patient is deceased and the physician 
accepts assignment, line 6 may be completed by the 
physician indicating “Patient is deceased”. 

(5) A physician treating a patient over an ex- 
tended period, who agrees to accept assignment, 
may obtain the patient’s consent to assignment 
of unpaid bills for an anticipated period of treat- 
ment by having the patient sign a statement as 
follows : 

“I request that payment under the Medical In- 
surance Program be made directly to Dr 

on any unpaid bills for the services furnished me 

by that physician during the period to 

” The period should extend no longer 

than the close of the calendar year, and the state- 
ment should be attached to the original claim and 
be submitted in the usual manner. On subsequent 
claims, the physician should indicate: “This is a 
continuation of a course of treatment for which 
the patient’s assignment was previously obtained.” 
This statement should appear in the signature box. 

When the physician accepts assignment for a 
recipient of Public Aid the SSA 1490 form should 
be completed in triplicate. Send the first copy of 
the SSA 1490 to your Medicare carrier, and the 
second copy to the Illinois Department of Public 
Aid, Medical Administration, 425 South Fourth 
Street, Springfield, Illinois, 62762. The third copy 
should be kept in your files. 

Medicare will allow 80 percent of the reasonable 
charge after the annual $60 Part B deductible has 
been satisfied. A copy of the Explanation of Medi- 
care Benefits (EOMB) indicating payment or non- 
payment will be sent to the Public Aid office. 
Public Aid will match this EOMB with their copy 
of the SSA 1490 and adjudicate the claim to make 
payment under the provision of the Public Aid 
law. 


(This report is a service to the physicians of Illinois) 




Illinois Medical Journal 

JULY, 1974 Vol. 146, No. 1 CONTENTS 


Special Articles 

19 Guidelines in the Selection of a Weight Control Program or Product 

23 Abstracts of the Board of Trustees Action 

33 Categorization of Hospital Emergency Medical Capabilities in Illinois: 

A Statewide Experience 

David R. Boyd, M.D.C.M., Winifred Anri Pizzano, B.A., 

Patricia A. Silverstone, B.A.Ed. and Teresa L. Romano, B.S.N. 


President’s Page 

12 A Challenge— Not An Invitation 

Fredric D. Lake, M.D. 


Clinical Articles 

25 Swimming Instruction for Pre-School Children 

Eugene F. Diamond, M.D. 

28 The Cholesterol Hypothesis and the Coronary Primary Prevention Trial 

Philip A. Hahak, M.D., Helmut G. Schrott, M.D. 
and William E. Connor, M.D. 

31 Rupture of the Heart— Report of a Case with One Week Survival 

Arnaldo G. Carvalho, M.D., F.A.C.C. 

47 The Changing Role of Neonatal Nursing 

Charlyn Slade, R.N., B.S.N. 


Surgical Grand Rounds 

39 Hemangiosarcoma of Breast 

John M. Beal, M.D. 


(Contents continued overleaf) 


for July, 1974 


5 


CONTENTS (continued) 


Features 

38 Clinics for Crippled Children 

42 View Box 

43 New Pharmaceutical Products 

45 EKG of the Month 

51 Doctor’s News 

53 Editorial 

54 Pulse of the Doctor’s Wife 

56 ISMS Guide to Continuing Medical 

Education 

63 Physician Recruitment 

65 Obituaries 

(Cover by Jane E. Bushwaller) 


Staff 

Editor Theodore R. Van Dellen, M.D. 

Managing editor Richard A. Ott 

Assistant editor Joyce Gallagher 


Executive administrator Roger N. White 


PUBLICATIONS COMMITTEE 

Jacob E. Reisch, M.D., Springfield, Chairman 
Eugene T. Hoban, M.D., Oak Park 
A. Edward Livingston, M.D., Bloomington 
James A. McDonald, M.D., Geneva 
Warren W. Young, M.D., Crete 


Contributor in Surgery: John M. Beal, M.D., Chicago 
Contributor in Medical Progress: Harvey Kravitz, M.D., Skokie 
Contributor in Maternal Death Studies: 

Robert Hartman, M.D., Jacksonville 
Contributor in Pediatric Perplexities: Ruth A. Seeler, M.D., Chicago 
Contributor in Radiology: Leon Love, M.D., Maywood 
Contributor in Cardiology: John R. Tobin, M.D., Maywood 


ILLINOIS STATE 
MEDICAL SOCIETY 

360 N. Michigan Ave., Chicago, 60601 

OFFICERS 

Fredric D. Lake, M.D., President 
1041 Michigan Ave., Evanston 60202 
J. M. Ingalls, M.D., President-Elect 
502 Shaw, Paris 61944 
Harold A. Sofield, M.D., 1st Vice-President 
715 Lake Street, Oak Park 60301 
Robert Hartman, M.D., 2nd Vice-President 
J515A W. Walnut Street, Jacksonville 62650 
Jacob E. Reisch, M.D., Secretary-Treasurer 
1129 S. 2nd St., Springfield 62704 

HOUSE OF DELEGATES 

Andrew J. Brislen, M.D., Speaker of the House 
6060 S. Drexel Blvd., Chicago 60637 
James A. McDonald, M.D., Vice-Speaker 
13 S. 2nd St., Geneva 60134 

TRUSTEES 

1st District: 1977, Joseph L. Bordenave, M.D., 
1665 South Street, Geneva 60134 
2nd District: 1977, Allan L. Goslin, M.D. 
712 N. Bloomington, Streator 61364 
3rd District: 1976, David S. Fox, M.D. 
20829 Greenwood Center Ct., Olympia Fields 60461 
3rd District: 1976, Robert T. Fox, M.D. 
2136 Robin Crest, Glenview 60025 
3rd District: 1975, Eugene T. Hoban, M.D. 

6429 North Ave., Oak Park 60302 
3rd District: 1975, Joseph Skom, M.D. 
707 Fairbanks Ct., Chicago 60611 
3rd District: 1977, William M. Lees, M.D. 
6518 North Nokomis, Lincolnwood 60646 
3rd District: 1977, George Shropshear, M.D. 

1525 E. 53rd St., Chicago 60615 
3rd District: 1977, Philip G. Thomsen, M.D. 

13826 Lincoln Ave., Dolton 60419 
3rd District: 1976, Frederick E. Weiss, M.D. 

15643 Lincoln, Harvey 60426 
3rd District: 1975, Warren Young, M.D. 

3450 Haweswood Dr., Crete 60417 
4th District: 1976, Fred Z. White, M.D. 
723 N. 2nd St., Chillicothe 61523 
5th District: 1976, A. Edward Livingston, M.D. 

326 Fairway Dr., Bloomington 61701 
6th District: 1975, Mather Pfeiffenberger, M.D. 

State and Wall Sts., Alton 62002 
7th District: 1976, Arthur F. Goodyear, M.D. 

142 E. Prairie, Decatur 62523 
8th District: 1976, Eugene P. Johnson, M.D. 

P.O. Box 68, Casey 62420 
9th District: 1975, Warren D. Tuttle, M.D. 

203 N. Vine St., Harrisburg 62946 
10th District: 1975, Herbert Dexheimer, M.D. 

301 S. Illinois, Belleville 62220 
11th District: 1977, Ross Hutchison, M.D. 
126 E. Ninth St., Gibson City 60936 
Trustee-At-Large: Willard C. Scrivner, M.D. 

6600 West Main, Belleville 62223 
Chairman of the Board: Joseph L. Bordenave, M.D. 

1665 South Street, Geneva 60134 


Microfilm copies of current 
as well as some back issues 
of the Illinois Medical Jour- 
nal may be purchased from 
Xerox University Microfilm, 
300 North Zeeb Road, Ann 
Arbor, Mich. 48106. 



Contents of 1MJ are listed in the Current Contents/ Clinical Practice. 

Published by the Illinois State Medical Society, 360 N. Michigan Ave., Chicago, 111. 60601 (312-782-1654) 
Copyright, 1974. The Illinois State Medical Society. 

Subscription $8.00 per year, in advance, postage prepaid, for the United States, Cuba, Puerto Rico, 
Philippine Islands and Mexico. $10.00 per year for all foreign countries included in the Universal Postal 
Union. Canada $8.50. U.S. Single current copies available at $1.00 ($1.10 by mail), back issues $1.50. 

Second class postage paid at Chicago, 111. When moving please notify Journal office of new address 
including old mailing label with notification, if possible. POSTMASTER: Send notice on form No. 3579 to 
Illinois State Medical Society, 360 N. Michigan Ave., Chicago, 111. 60601. 

Pharmaceutical advertising must be approved by the ISMS Publications Committee. Other advertising 
accepted after review by Publications Committee or Board of Trustees. All copy or plates must reach the 
Journal office by the fifteenth of the month preceding publication. Rates furnished upon request. 

Original articles will be considered for publication with the understanding that they are contributed only 
to the Illinois Medical Journal. The ISMS denies responsibility for opinions and statements expressed by 
authors or in excerpts, other than editorial or allied views or statements which reflect the authoritative action 
of the ISMS or of reports on official actions, policies or positions. Views expressed by authors do not 
necessarily represent those of the Society; any connection with official policies is coincidental. 



cannibal stomach 


*Fordtran, J. S., and Collyns, J. A. H.: Antacid 
Pharmacology in Duodenal Ulcer: Effect of 
Antacids on Postcibal Gastric Acidity and 
Peptic Activity, New England J. Med. 
274:921-927 (April 28) 1966. 


add Pro-Banthine 

Helps to relieve pain without risk of patient drug 
dependency. 


add Pro-Banthine 


Reduces gastric secretory volume and total 
resting and free acid without the caloric, 
digestive, and social problems occasioned 
uent eating. 


by 


Pro-Banthine 


Pro-Banthine slows intestinal motility to 
enhance and prolong the action of 
antacids. The action of Pro-Banthine 
lasts 4 to 6 hours. 


Searle & Co. 

San Juan, Puerto Rico 00936 


Address medical inquiries to: G. D. Searle & Co. 
Medical Department, Box 5110, Chicago, III. 60681 


SEARLE 


3 


ilij 
' 0 


2 1 

iK 

» I 

5 




usually get better patient response. 


occur as well as mydriasis and blurred vision. In addition the following 
adverse reactions have been reported: nervousness, drowsiness, dizziness, 
i insomnia, headache, loss of the sense of taste, nausea, vomiting, constipa- 
tion, impotence and allergic dermatitis. 

Dosage and Administration: The recommended daily dosage for adult 
oral therapy is one 15-mg. tablet with meals and two at bedtime. Subse- 
quent adjustment to the patient's requirements and tolerance must be 
made. 

Pro-Banthine P. A. — Each tablet of Pro-Banthine RA. (propantheline 
bromide) contains 30 mg. of the drug in the form of sustained-release or 


timed-release beads; on ingestion about half of the drug is released within 
an hour and the remainder continuously as earlier increments are metab- 
olized. Thus the result is even, high-level anticholinergic activity main- 
tained all day and all night in most patients with only two tablets daily. 
Some patients may require one tablet every eight hours. 

The contraindications and precautions applicable to Pro-Banthine 15 
mg. should be observed. 

How Supplied: Pro-Banthine is supplied as tablets of 15 and 7.5 mg., as 
prolonged-acting tablets of 30 mg. and, for parenteral use, as serum- 
type vials of 30 mg. 


389 


President’s Page 


A Challenge- — 

Not An Invitation 

pilllllililllllllllilliilllliiiiillllliliilllliilllillllllll 

All too frequently I hear the complaint that the state medical 
society “does not represent me.” This tune is sung by physicians who 
have made no effort to be represented. Often they have not par- | 

ticipated nor made the least effort to become involved in the af- | 

fairs of their county society or ISMS. They have permitted their 
“representatives” to be chosen for them by others. g 

Also heard — all too often — is the complaint that a small clique 
runs the show. If true, this is so only because the body politic — the 1 

grass roots — permits this to happen by abdicating its rights — 

1 especially the electoral franchise. 1 

The privilege of authoring this page has befallen me not because 
I had the right “school tie” nor because I was a member of the 
“power bloc” — I have neither of these qualifications. I hold my office 
because within the “halls of medicine” I have dared to address the 
issues and to speak my piece. g 

In my previous message on this page, I invited the membership 
to make known to the House Select Committee its views on the 
problems besetting the society, and to offer any suggestions on its 
governance, organization and operations. I pointed out that this is 
your opportunity to participate in restructuring ISMS and eliminating J 

its troubles. 1 

I have received some disconcerting feedback from this invitation. 

There are physicians who predict that the Select Committee will 
lay a sterile egg. To them I suggest that the Committee can fail only 
if you, the members of ISMS, let it fail. The recommendations of this 
committee will be reported at the House of Delegates in April, 1975. g 

What those recommendations will be depends upon you. g 

The action of your delegates will determine the success or failure 1 

of this monumental effort. If you ordain the needed changes, your | 

delegates dare not ignore you. 



Submit comments to Committee Chairman and ISMS President-Elect J. M. Ingalls, M.D., g 

502 Shaiu Avenue, Paris, III. 619II . 

illllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllM 



12 


Illinois Medical Journal 


Guidelines in the Selection of 
A Weight Control Program or Product 


At its recent meeting, the ISMS Board of Trustees approved the “Guidelines 
In the Selection of A Weight Control Program or Product.” These “Guidelines” 
were produced to inform patients what to look for when selecting a weight reduc- 
tion regimen. Copies of the “Guidelines” are available for distribution to patients 
or for display in physicians offices; contact: ISMS headquarters, 360 N. Michigan 
Ave., Chicago, 60601. 


1. CONSULT a physician to make sure the 
program or product is safe for you. Most 
diets, drugs, exercises, and products are de- 
signed for people in good physical condition. 
It is imperative to have a doctor’s approval 
BEFORE BEGINNING potentially danger- 
ous weight control procedures or products. 

2. BE WARY of deceptive advertising. NO 
SINGLE ITEM CAN OFFER GUARAN- 
TEED RESULTS. 


S. KNOW what “medical supervision” means. 
Programs which do not have a physician, 
licensed to practice medicine in all of its 
branches, on the premises at all times, are 
not medically supervised. 

4. SEE a physician regularly while participat- 
ing in a weight control program or using a 
reducing product. Such check-ups will insure 
that the program or item is not deleterious 
to your health. 


5. FIND out if drugs are to be used in a weight 
reduction program. If so, medical supervi- 
sion is essential. 


6. BEWARE of any drug used for weight con- 
trol which has not been approved by your 
physician. Drugs like Human Chorionic 


Gonadotropin (H.C.G.) are considered ex- 
perimental, and are not F.D.A. approved for 
weight control. To determine the status of 
a particular drug, consult your physician. 


7. CHECK diet regimens with a physician or 
local health department to insure that they 
meet the nutritional requirements necessary 
to maintain good health. 


8. REMEMBER, exercise should accompany 
any weight loss for increasing energy output 
and toning tissues and muscles. However, 
exercise alone is inadequate for losing 
weight, and could be harmful if not properly 
supervised or structured to meet your limita- 
tions. 


9. BE WARY of special drugs, fad diets, or 
mechanical reducers which guarantee dram- 
atic losses in weight. Any sudden change in 
weight is potentially hazardous. Body wrap- 
pings, in particular, should be discouraged. 
These can be dangerous, and may cause 
severe circulation ailments. 


10. REMEMBER, the “secret” of weight con- 
trol is a “RETRAINING” of eating habits. 
This will help maintain the weight you lose. 
Any program which fails to do this is inade- 
quate. M 


for July, 1974 


19 



Dalmane 

(flurazepam HCI) 


Distinctiveness 
that begins with the 
benzodiazepine 

structure 


Distinctive sleep potential 
in the flurazepam HCI 
molecule 


Dalmane (flurazepam HCI) is a distinctive 

sleep medication— a benzodiazepine 
specifically indicated for 
insomnia. It is not a barbiturate 
or methaqualone, nor is it 
related chemically 
to any other available chjCh p n(c 2 h 5 ) 2 
hypnotic. 

In the most rigorous course 
of clinical evaluation ever 
accorded a sleep medication in the sleep research 
laboratory, Dalmane has repeatedly been shown 
effective in helping patients fall asleep promptly, stay 
asleep and sleep longer . 1 ' 7 



2 HCI 


20 


Illinois Medical Journal 


Abstracts of Board Actions 


June 1-2, 1974 Chicago 

These abstracts are published so that members of the Illinois State Medical Society may keep advised of the actions 
of the Board of Trustees. It covers only major actions and is not intended as a detailed report. Full minutes of the 
meetings are available upon any member’s request to the headquarters office of the ISMS. 


1974 Annual Meeting 

The Board of Trustees agreed that ISMS would underwrite up to $11,500 of def- 
icit incurred by the scientific program planned in conjunction with the 1975 
Midwest Clinical Conference and the annual meeting of ISMS. The agreement is 
contingent upon a uniform accounting system being developed by the treasurers 
of ISMS and the Chicago Medical Society. The subsidy was necessitated by the 
decision to discontinue technical and scientific exhibits. 

TAP Institute 

The Executive Committee was authorized to decide if ISMS should co-sponsor a 
"Trustee-Administrator-Physician" TAP Institute to be conducted in October 
by the Joint Commission of Accreditation Hospitals. If the Executive Committee 
judges the institute's program content to be contrary to ISMS policy, partici- 
pation will be declined. 

Outlook Sanatorium 

The Board approved and forwarded to the Champaign County Medical Society a 
report presented by an ISMS physician committee following its inspection of the 
Outlook Sanatorium in Champaign. The report refuted adverse findings of the 
Illinois Department of Public Health Tuberculosis Advisory Committee. The 
Board authorized the Champaign Medical Society to release the ISMS report to 
the press. 

Benevolence Fund 

All applicants for benevolence and annual renewals of aid will be screened 
by the appropriate district trustee, who may call upon the county medical so- 
ciety or its auxiliary for assistance in checking eligibility. 

Amendments to Emergency Medical Treatment Act 

In a followup to previous action, the Board approved ISMS introduction of 
amendments to the Emergency Medical Treatment Act in the current session of the 
legislature. 

National Blood Program 

Endorsement of the American Blood Commission Plan was approved by the Board 
and the Department of Health, Education and Welfare was notified. 

Resolution on Family Practice 

The Board withheld approval of a resolution asking the General Assembly to re- 
quire medical schools to report their progress in developing and expanding fam- 
ily practice departments. Further action will depend on the position taken by 
the Illinois Academy of Family Physicians on this matter. 

PSRO Ad Campaign 

Following a progress report on the campaign to inform the public of the dele- 
terious effects of PSRO, the Board directed that a sample "Confidentiality" en- 
velope stuffer be mailed to all ISMS members with an order blank on which addi- 
tional copies may be requested. 

In a related action, the Board instructed the AMA delegation to support in the 

( Continued on page 58) 


for July , 1974 


23 





. 


Kefzol 

cefazolin sodium 

Ampoules, equivalent to 1 Gm. of cefazolin 


Additional information available 
to the profession on request. 

Eli Lilly and Company 
Indianapolis, Indiana 46206 
400380 


24 


Illinois Medical Journal 




Swimming Instruction for Pre-School Children 


By Eugene F. Diamond, M.D. /Maywood 


Accidents are the leading cause of death be- 
tween one and four years of age and drowning 
is the number three cause of fatal accidents in 
this age group. About 15% of all fatal accidents 
between ages one and four years are due to 
drowning. The circumstances of these drownings 
are shown in Figures 1 - 4. 

The American Academy of Pediatrics is, there- 
fore, concerned about the 2,500 deaths each year 
due to drowning, including the over 800 infants 
under four years of age who drown. We do not 
wish to delay the learning of water skills for 
so long as to be teaching swimming only to a 
few survivors. 

On the other hand, we are aware that one of 
the unfortunate characteristics of this modern 
era is excessive adult intrusion into juvenile 
recreation. Particularly in suburbia, inappro- 
priate pressures tend to be brought on immature 
children to develop all kinds of skills at a rate 
not in keeping with orderly process of neuro- 

EUGENE F. DIAMOND, M.D., is Pro- 
fessor of Clinical Pediatrics at Loyola 
University Stritch School of Medicine. 
Dr. Diamond served residency programs 
in internal medicine and pediatrics. He 
is the author of numerous scientific 
publications. An active member of the 
American Academy of Pediatrics, Dr. 
Diamond is presently the Chairman of 
their Joint Committee on Physical Fitness. 



Figure 1 


muscular development and maturation. The 
laudable efforts of Little League baseball, Pop 
Warner football, and pee-wee hockey to broaden 
the base of juvenile sports participation are 
often frustrated, if not negated, by over-zealous 
parents looking for vicarious gratification. 

It was against this background of dilemma 
and mixed emotions that the Joint Committee 
on Physical Fitness, Recreation and Sports went 
about the development of an official statement 



for July, 1974 


25 



per Cent of Drownlngs* 

35.1 



Relative Frequency of Drownlngs by 
Temperature of Water 

Figure 2 



Figure 3 



Relative Frequency of Drownlngs by Swimming Ability 

Figure 4 


on Swimming Instruction for Infants. The text 
of the statement is as follows: 

Swimming Instruction For Infants 

Children less than three years old are most 
vulnerable to drowning, and organized attempts 
to reduce the toll are indicated. 

Swimming instruction, heretofore, has concen- 
trated on school age children. Recent efforts have 
been focused on teaching young children to swim, 
even during the first year of life. It may be pos- 
sible to teach very young infants to swim and 
keep their heads above water, but it is question- 
able whether or not an infant can truly be taught 
water safety and proper reaction to an emergency. 
Parents can develop a false sense of security if 
they know that their young infant can swim a 
few strokes. 

Additional problems are associated with admis- 
sion of infants to public pools. Incontinent infants 
in pools certainly pose an aesthetic problem, and 
it is difficult to maintain the effectiveness of chlor- 
ination. In addition, infants with age-specific 
immunity handicaps would be subject to sig- 
nificant exposures to enteroviruses, adenoviruses, 
and other potentially dangerous microorganisms 
in dosages not likely to be found under con- 
trolled home conditions. 

Considerations involved in the use of swimming 
as a form of ‘‘patterning” are not of sufficiently 
established benefit to be weighed as factors in 
favor of early pool training. 

It is not recommended that large-scale programs 
he undertaken to teach swimming to children 
under the age of three years. 

However, it is recommended that efforts to 
reduce the incidence of drowning in children 
under three years of age should concentrate on 
three measures of proven effectiveness: 

1 . More adequate fencing and other protective 
measures to exclude infants from pool areas 
or areas of excavation. 

2. The assurance of constant parental or other 
adult supervision for all non-swimmers in 
swimming areas. 

3. The use of flotation jackets for all non- 
swimmers close to bodies of water or in 
boats. 

The Academy of Pediatrics is represented on 
the Council for National Cooperation in Aquat- 
ics. At the November, 1971, meeting of the 
council, our representative with representatives 
from YWCA, YMCA, American Red Cross, Boys 
Clubs of America, The United States Office of 
Education and representatives from The Schools 
of Physical Education at Purdue and Yale Uni- 
versities developed the following statement on 
the subject of pre-school swimming: 

Because certain considerations affecting a child’s 
learning and safety require a degree of develop- 
ment not attained by most children before they 
are three years old, the Council for National 
Cooperation in Aquatics recommends that the 


26 


Illinois Medical Journal 


minimum age for organized swimming instruction 
be set at age three. It is imperative that parents 
be made to realize that even though pre-schoolers 
may learn to swim, no young child, particularly 
the pre-schooler, can ever be considered “water 
safe” and must be carefully supervised when in 
or around water. 

Guiding Principles 

For organized pre-school swimming programs, 
CNCA recommends the following guiding prin- 
ciples: 

1 . Pertinent health information about pre- 
existing conditions which would affect a 
child’s ability to participate in the activities 
should be obtained from the parents before 
a child is accepted into an organized swim- 
ming program. 

2. Swimming instruction of pre-school children 
requires a staff of sufficient number to pro- 
vide a very low ratio of instructors or aides 
to children. This requirement may be met 
by using parents and other volunteer aides 
working directly under professionally com- 
petent leaders. 

3. Parents involvement in and understanding 
of the program is essential. Their orienta- 
tion should include: 

(a) Complete understanding of program 
objectives. 

(b) A clear picture of the skills that can be 
developed by the young child as well 
as the realization of his limitations. 

(c) Their responsibility in supplementing 
and enhancing the role of the instruc- 
tor. 

(d) Accepting their role in the supervision 
of the pre-school child any time the 
child is near water. 

4. Orientation of the child to facilitate adjust- 
ment to the total physical environment 
should precede the first class experience. 

5. The learning of skills of the young child is 
directly related to active participation in the 
instructional programs and to frequency of 
practice; the retention of skills is dependent 
upon reinforcement through frequent op- 
portunity to participate. 

G. The water temperature usually found in 
multiple-use indoor pools (in the range of 
78-82°) is acceptable for most children in 
this age group, provided that the teaching 
procedures include continuing vigorous ac- 
tivity. 

7. Suitable flotation devices when used in a 
controlled teaching situation help promote 
safer participation and can enhance learning. 

It is entirely appropriate to begin instructional 
programs after infancy in the three-seven year 
age group. Our main reluctance is to recommend 
organized programs for those under three years 
of age, and we recognize that individuals will 
still wish to undertake instructions for their own 
infants. We recognize that there is some disagree- 
ment as to whether or not it is possible to 
accommodate chlorination to the increased con- 
tamination incurred by allowing incontinent 


infants to swim. The increased susceptibility of 
infants to enterovirus and adenovirus infection 
is a real problem and not reducible by any 
program of pool antisepsis. The alleged benefits 
of infant swimming programs as “patterning” 
or “sensitivity” sessions are highly controversial. 
If there are benefits, they are as readily attain- 
able on land as in water. 

The American Red Cross estimates that there 
are 90 million non-swimmers in this country. 
Efforts to reduce this number are entirely ap- 
propriate to the prevention of death by drown- 
ing. Swimming instruction programs will be 
most successful, however, when they take realistic 
account of the realities of growth and develop- 
ment. 

The techniques of swimming instructions are 
beyond the scope of this presentation. It is 
important to emphasize, however, that all rules 
of child guidance are not suspended by the 
desire to teach a child to swim. The initial 
skills usually taught are breath control, prone 
float, and dog paddle. When dealing with young- 
er children, it is probably true that one is likely 
to encounter a smaller percentage of students 
who have a pathological fear of water. It also 
is probably true that fears of water are not 
always reconciled by persuasion or logical ex- 
planation of hazards and safeguards. There is, 
however, an inclination to circumvent the need 
for explanation and education in the younger 
age groups. Because of the instructor’s obvious 
superiority in size and strength, there is a temp- 
tation to resort to compulsion and intimidation. 
All of us have seen the dramatic change which 
can come over a young child through even a 
brief successful experience in the water. In order 
to bring about this important initial achieve- 
ment, it may be necessary to resort to firmness, 
pressure and even coercion at times as long as 
the pervading background is one of gentleness 
and sympathy. All programs of swimming in- 
struction which include, as basic instructional 
techniques, throwing children into the water or 
holding children under water will be viewed 
askance by pediatricians. Those who contend 
that such techniques are necessary and innocuous 
will have to support their view points with 
prospective studies and objective psychological 
data. Retrospective claims, short-term observa- 
tions, and disclaimers based on prestige and ex- 
perience will not necessarily be admissable. 
Neither will it be possible to justify every 
technique of instruction on the basis of overall 
success of a program in teaching children how 
to swim. 

(Continued on page 61) 


for July, 1974 


27 


The Cholesterol Hypothesis and the Coronary 
Primary Prevention Trial 


By Philip A. Habak, M.D., Helmut G. Schrott, M.D., and 
William E. Connor, M.D./Iowa City, Ia. 


H eart disease is presently the leading cause of 
death in the United States, ranking well 
above cancer, accidents and infections. In 1967, 
54.1% of all deaths were due to cardiovascular 
disease and approximately 626,000 deaths from 
atherosclerotic and degenerative heart disease 
were reported during the same year. 1 In men be- 
tween 40-59 years of age, the death rate is even 
greater, reaching about 8 per 1000 per year. 

Among the various coronary risk factors, the 
level of serum cholesterol has attracted much in- 
terest recently. The Framingham heart study 2 
and other studies have clearly identified the level 
of serum cholesterol as a major risk factor for 
atherosclerotic coronary heart disease. Further- 
more, the relationship between an elevated serum 
cholesterol and atherosclerosis is supported by 
the discovery that in several species of animals 
atherosclerotic lesions can be produced by high 
cholesterol, high saturated fat diets 3 - 4 and by the 
experiments of Taylor et al 5 who were able to 
induce fatal myocardial infarctions in Rhesus 
monkeys fed a high cholesterol diet. 

More recently, Armstrong, et al 6 reported that 
regression of arterial plaques occurred in mon- 
keys when a low cholesterol diet was subsequent- 
ly introduced suggesting that at least in that 
species, the process may be reversible. In man, 
however, regression of the disease has not been 
observed and whether measures to reduce serum 
cholesterol are effective in preventing coronary 
heart disease is still open to question. Most 
studies of the efficacy of dietary or drug treat- 
ment were secondary prevention trials in that 
patients with documented coronary heart dis- 
ease were entered into treatment programs and 
observed for varying lengths of time. For exam- 
ple, the Oslo diet heart study included 412 men 
one to two years post myocardial infarction who 
were randomly allocated into diet treatment and 

The authors are from the Lipid Research Clinic, Cardiovascular 
Division of Department of Internal Medicine at The University 
of Iowa College of Medicine, Iowa City, la. 


control groups. 7 After five years, the diet treat- 
ment group had signicantly fewer myocardial in- 
farctions. However, the difference in the death 
rate was not statistically significant. In England, 
a similar study involved 395 persons who were 
divided into diet treatment and control groups. 9 
The treatment group had fewer coronary events 
but the difference was not statistically significant. 
Actually, the treatment group had slightly more 
cardiovascular deaths. Diet studies such as these 
are not convincing because of small numbers, 
reliance on soft end points, and use of subjects 
with advanced coronary heart disease. If high 
risk groups had been selected, i.e. hypercholes- 
terolemic men, and entered into the different 
treatment groups before the development of 
coronary heart disease, the results might have 
been different. 

The Coronary Primary Prevention Trial is 
well under way in several Lipid Research Clinics 
throughout the country. It is a centrally coor- 
dinated, randomized, double blind primary pre- 
vention study using patients with type II hy- 
perlipoproteinemia (hypercholesterolemia) and 
designed to substantiate the lipid hypothesis and 
the efficacy of intervention. The patients admitted 
into the study will have an elevated serum cho- 
lesterol level mainly secondary to an increase in 
the concentration of low density or beta-lipopro- 
teins. These lipoproteins contain a greater pro- 
portion of cholesterol than the other lipoproteiq 
fractions and there is a high correlation between 
their concentration and the incidence of athero- 
matous disease both in animals and in man. 10 
Beta-lipoproteins are synthesized by the liver and 
gut and their serum concentration depends on 
the balance between synthesis and degradation. 
The role of dietary cholesterol, fat content and 
the ratio between polyunsaturated and saturated 
fats in the genesis of atherosclerotic vascular dis- 
ease may be related to alterations in the concen- 
tration of the beta-lipoproteins in the plasma. 

Physicians in western Illinois, within a 50 mile 
radius from the Quad-Cities will have the oppor- 


28 


Illinois Medical Journal 


tunity to play a substantial role in this unique 
and important cooperative study. Thus, the se- 
lection and referral of patients to the Lipid Re- 
search Clinic in Iowa City is primarily depen- 
dent on the active participation of interested 
physicians in practice in their respective com- 
munities. 

The Lipid Research Clinics 

The Lipid Metabolism Branch of the National 
Heart and Lung Institute was created in Decem- 
ber, 1970. A network of continent-wide Lipid 
Research Clinics located in 12 universities in the 
United States and Canada was established. Their 
major objectives included the performance of 
studies on the prevalence and natural history 
of the hyperlipoproteinemias and a primary pre- 
vention trial on patients with hypercholesterole- 
mia. 

The University of Iowa is among the institu- 
tions which were approved to participate in this 
major research goal and to host a Lipid Research 
Clinic. The Iowa Lipid Research Clinic staff will 
offer consultation and assistance to all physicians 
encountering management problems in patients 
with disorders of lipid metabolism. The Lipid 
Core Laboratory of the Clinic has been standard- 
ized according to the Lipid Standardization Lab- 
oratory of the Communicable Disease Center in 
Atlanta, Ga. The University of Iowa Lipid Lab- 
oratory will be available as a reference for the 
standardization of other laboratories which per- 
form various blood lipid studies and would pro- 
vide assistance to any clinical laboratory wishing 
information regarding specific technical prob- 
lems in the lipid field. The protocol for the pri- 
mary prevention trial, also known as the Lipid 
Research Clinics Type II Coronary Primary Pre- 
vention Trial, was approved by the Lipid Re- 
search Clinics Directorate in November, 1972. 

The Primary Prevention Trial Protocol 11 

I. Patient Population 

A minimum of 300 men per clinic, 35-59 years 
of age, will be enrolled in the project. These men 
will have hypercholesterolemia (type II hyper- 
lipoproteinemia) and thus are coronary prone 
individuals. Type II hyperlipoproteinemia is 
characterized by elevated levels of serum choles- 
terol, beta-lipoproteins and a clear fasting serum. 
It is sometimes associated with tendon nodules 
(xanthoma tendinosa) , xanthelasma, and (less 
frequently) skin xanthomas of the tuberous type. 
Frequently it is an hereditary disorder, trans- 


mitted as a simple Mendelian dominant trait, but 
may also occur in part secondary to a cholesterol- 
fat rich diet, hypothyroidism, nephrosis, dyspro- 
teinemias or obstructive liver disease. The pa- 
tients referred to the prevention study should 
be healthy men having no angina pectoris, his- 
tory of a myocardial infarction, coronary insuf- 
ficiency or heart failure as well as severe hyper- 
tension. Patients with diabetes mellitus, other 
endocrine disorders and diseases limiting life 
expectancy to less than five years also are not 
eligible for the sutdy. In addition, they should 
not be receiving any of the following medica- 
tions: estrogens or androgens, thyroid, corticos- 
teroids, anticoagulants, quinidine, procainamide 
or digitalis, 

II. Recruitment 

The enrollment of 300 men with type II hyper- 
lipoproteinemia between the ages of 35 and 59 
years into the study will require the screening 
of a much larger population that may amount 
to 10,000 subjects. Western Illinois and Eastern 
Iowa physicians will play a central role in iden- 
tifying and referring these patients. Candidates 
for this program should have cholesterol levels 
greater than 285 mg%. We would like to stress 
the fact that the referring physician remains the 
primary physician for the patient, with the Lipid 
Research Clinic staff serving only as consultants 
in the special area. The referring physician will 
be furnished a copy of the initial medical eval- 
uation, the cardiovascular workup and the re- 
sults of all screening tests as well as reports of 
subsequent examinations. 

It also should be mentioned that all patients 
referred to the study stand to benefit. These are 
some of the advantages to the participants: 1) 
general medical workup: 2) lipid and cardiovas- 
cular workup; 3) all patients will receive dietary 
counseling; and 4) there are no costs to the 
patient. Furthermore, since there is a familial 
preponderance of hypercholesterolemia, family 
members including siblings and children also 
may indirectly benefit. 

III. Preliminary Evaluation 

All patients will undergo an initial evaluation 
which will be spread over five monthly visits. 
The study will be explained to the patients in- 
dividually and their consent will be obtained. 
The initial screening process will include testing 
for diabetes mellitus and for disorders of the 
thyroid, liver and kidneys as well as a complete 
cardiovascular evaluation. Thus, in addition to 
a complete history and physical examination, 
some of the visits will include a blood lipid pro- 
file, blood counts and blood chemistry, an elec- 


for July, 1974 


29 


trocardiogram as well as a treadmill exercise 
test. All laboratory results obtained in the initial 
period will be communicated to the patient’s pri- 
mary physician and only those individuals who 
successfully complete this screening program, the 
most coronary prone men, will be eligible for the 
treatment phase of the study. 

IV. The Treatment Phase of the Study 

At Visit 2, the patients will be placed on a 
cholesterol modified diet. This diet is best de- 
scribed as a prudent diet. It is expected to pro- 
duce some reduction in the serum cholesterol 
level. At Visit 5, following completion of the 
preliminary workup, the patient is randomly al- 
located to one of two treatment groups: the diet 
and placebo group or the diet and Cholesty- 
ramine group. Cholestyramine is a bile acid 
sequestrant which is expected to achieve an 
average reduction in serum cholesterol of about 
20%. The drug has been used at the University 
of Iowa and elsewhere for eight years and has 
been found to be remarkably free of serious side 
effects. Cholestyramine was approved by the Food 
and Drug Administration on August 6, 1973. 

If we can conclusively establish that lowering 
the cholesterol level can prevent premature 
coronary heart disease, then the time and effort 
expended to vigorously treat high risk patients 
will be worthwhile. Because such a study is im- 
portant from a personal and family point of view 
as well as from a national standpoint, it is. nec- 
essary to eliminate bias in the conduct of the 
investigation which might mitigate against the 
results. Accordingly, neither the patient nor the 
physician seeing him in the Lipid Research Clin- 
ic will know whether drug or placebo is being 
dispensed. The patient’s lipid levels in the treat- 
ment phase are mailed to a Central Patient Reg- 
istry located in Chapel Hill, North Carolina, and 
will not be known to either the clinic physicians 
or the patient’s primary physician. The patient’s 
physician also will be requested to refrain from 
ordering blood cholesterol determinations on pa- 
tients enrolled in the project to avoid unblind- 
ing the study. Should it become important for 
medical care, the information on a certain pa- 
tient’s lipid studies or treatment can be obtained 
from the local Lipid Research Clinic. 

V. Follow-Up Phase 

During the follow-up period, which is expected 
to last five to seven years, the subjects will be 
seen in the Lipid Research Clinic at two month 
intervals for blood lipid determinations and 
screening for side effects. A more extensive out- 
patient evaluation will be performed every six 
months and a stress electrocardiogram will be 


obtained once a year. 

VI. End Points 

Primary end points in the study are a definite 
non-fatal myocardial infarction or a definite 
atherosclerotic heart disease death (fatal myo- 
cardial infarction, sudden death). Other response 
variables include different forms of arterial athe- 
rosclerotic disease; arterial peripheral vascular 
disease and cerebral vascular disease are consid- 
ered here. 

VII. Safety and Data Monitoring Board 

A Safety and Data Monitoring Board will re- 
view all the data accumulated during the study. 
The board may recommend changes in the de- 
sign of the study or its premature termination 
on the basis of toxicity data or whenever a sig- 
nificant difference in end points is found between 
the control and the treated group. At the end of 
the follow-up period, based on the findings and 
conclusions gathered, appropriate treatment of 
patients in the study will be recommended. 

How to Refer Patients 

Interested physicians can refer potential can- 
didates for this program by writing or calling 
the Iowa Lipid Research Clinic at S-228 West- 
lawn, Iowa City, Iowa 52242; telephone number 
319-356-2095. Physicians in Southern Illinois may 
wish to refer their patients to Dr. Gustav Schon- 
feld or Dr. Joseph Witztum at the St. Louis Lipid 
Research Clinic, Washington University School 
of Medicine, Box 8046, 4566 Scott Avenue, St. 
Louis, Missouri 63130; telephone number 314- 
454-3461. ◄ 

References 

1. Vital Statistics of the United States, 1967, Volume 
II, Mortality, Part A, National Center for Health 
Statistics, U.S. Dept, of Health, Education and Wel- 
fare, Public Health Service, U.S. Government Printing 
Office, Washington, D.C., 1969. 

2. Dawber, T. R., Moor, F. E. and Mann, G. V.: “Coro- 
nary Heart Disease in the Framingham Study.” Arner. 
J. Pub. Health (Suppl) 47:4-24, 1957. 

3. Anitschkow, N. N.: A History of Experimentation 
on Arterial Atherosclerosis in Animals, Cowdry’s 
Arteriosclerosis. Second edition, edited by H. T. 
Blumenthal, Springfield, 111., C. C. Thomas, 1967, 
pp. 21-44. 

4. Roberts, J. C. Jr., Straus, R.: (Editors) Comparative 
Atherosclerosis. New York, Harper and Rowe, 
Hoeber Med. Division, 1965. 

5. Taylor, L. B., Cox, G. E., Counts, M., and Yogi, N.: 
“Fatal Myocardial Infarction in Rhesus Monkeys with 
Diet-Induced Hypercholesterolemia.” Circulation 20, 
975, 1959. (Abstract) 

6. Armstrong, M. L., Warner, E. D., and Connor, W. E.: 
“Regression of Coronary Atheromatosis in Rhesus 
Monkeys.” Circ. Res. 27:59-67, 1970. 

(Continued on page 61) 


30 


Illinois Medical Journal 


health sciences LJBRAM 

UNIVERSITY of MARYLAND! 

Baltimore 


Rupture of the Heart 

Report of a Case With One Week Survival 


By Arnaldo G. Carvalho, M.D., F.A.C.C./Springfield 

Because of the marked progress made during the last few years in the prompt 
recognition and treatment of arrhythmias in patients with acute myocardial in- 
farction, most deaths in coronary care units today are the result of congestive 
heart failure, shock or rupture of the heart. 

The incidence of cardiac rupture is between 4 and 13% of fatal cases. 1 Recently 
attention has been focused on certain characteristic electrocardiographic patterns 
that occur in cardiac rupture. Mogensen et al 2 reported seven patients with rup- 
ture and tamponade whose electrocardiograms were monitored during the 
terminal event: all had abrupt onset of bradycardia, initially of sinus origin and 
then nodal. Meurs et al 3 reported 8 patients who had slowing of sinus rhythm 
followed by nodal rhythm. 

The present report deals with the electrocardiographic findings in a patient 
with rupture of the heart; the case was unusual because the patient survived for 
several days following the initial manifestations of cardiac rupture. 


Case Report 

A 67-year-old female, was admitted to Saint 
Johns Hospital on 9/9/72 with chest pain radi- 
ating to the left arm. She gave a history of angina 
for 8-10 years with crescendo angina for one 
month prior to admission. Chest pain recurred 
over the next several days requiring the admin- 
istration of opiates. At 4 p.m. of 9/12 she com- 
plained of chest pain on inspiration. At 9:05 a.m. 
of 9/13, while she was sitting in bed and a phy- 
sician was listening to her lungs, she suddenly 
became unconscious; no blood pressure or pulse 
could be obtained. Monitor strips at that time 
and during the next 40 minutes showed alternat- 
ing A-V dissociation, sinus tachycardia and A-V 
block. (Fig. 1) 

Resuscitative measures including an attempt 
at pericardiocentesis were carried out and cir- 
culation was restored. Over the next several hours 
administration of levaterenol was necessary in 
order to maintain the blood pressure. Her condi- 
tion continued to improve, however, and ad- 
ministration of levarterenol was discontinued 
at 9 p.m. 

ARNALDO GOMES CARVALHO, M.D., 
is Chief, Cardio-Vascular Department, 
St. John's Hospital, Springfield and is 
Clinical Associate Professor, Southern 
Illinois University School of Medicine. 
Dr. Carvalho is a Fellow, American 
College of Cardiology and certified by 
the American Board of Cardiovascular 
Diseases. 


During the next several days she had ventric- 
ular ectopic beats which were controlled with 
Lidocaine. On 9/19 at 9:15 p.m. she had ven- 
tricular tachycardia followed by bradycardia and 
cardiac arrest. (Fig. 2) 

Post-mortem examination showed the pericar- 
dial sac to be distended by 250 cc of semi-clottecl 
blood, mostly adherent to the inferior surface of 
the heart. The heart weighed 320 gm. An exten- 
sive transmural myocardial infarction involved 
most of the inferior left ventricular wall. At ap- 
proximately the mid-point of the infarcted area 
a probe patent small area of dissection through 
the necrotic muscle was demonstrable; adherent 
clots were found around and external to this 
zone. 

Discussion 

This case illustrates some of the features com- 
monly associated with cardiac rupture, which is 
more common in women 4 (6.9% of fatal myo- 
cardial infarction vs. 3.8% in men) and usually 
occurs in the seventh decade or later. 1 Hyper- 
tension is present in a large percentage of pa- 
tients. 

The concept that cardiac rupture can be diag- 
nosed only in the moribund patient or at autopsy 
probably is not true today. Van Tassel’s 1 data 
suggest that rupture of the heart may be clin- 
ically evident for a sufficient period of time prior 
to death to permit the diagnosis to be made. 
Biorck et al 5 made the clinical diagnosis in eight 



for July, 1974 


31 




Figure 1. Note atrial premature beats (9:05) 
s ; nus tachycardia (9:15), A.-V. dissociation 
(9:45), Mobitz type IA-V block (9:45). 

A-V — atrio-ventricular 

patients on the basis of a sudden circulatory 
arrest in association with sustained QRS con- 
figuration for some minutes. Meurs 3 and Mogen- 
sen 2 suggest that bradycardia wotdd be present 
in all such patients. The number of patients 
reported is rather small, however, and at this 
time it cannot be said with certainty that brady- 
cardia is a sine qua non for the clinical diagnosis 
of myocardial rupture. It was not present in our 
patient. 

It might be argued that rupture did not occur 
on 9/13 but rather just prior to death on 9/19. 
This is unlikely for several reasons. In patients 
dying from myocardial infarction, sinus rhythm 
is not often found at the time of circulatory 
arrest. In Biorck’s series of 529 patients with 
acute myocardial infarction there was one false 
positive diagnosis. In our patient the presence of 
markedly adherent clots to the walls of the path- 
way formed by the tear and the appearance of 
semi-clotted blood also suggest that the clinical 
fundings on 9/13 were related to the rupture. It 


certainly is possible that clots may seal the per- 
foration after only a small amount of blood has 
leaked into the pericardial sac, as is the case in 
false aneurysm of the left ventricle. 

What practical conclusions can be derived from 
this report? Since rupture of the myocardium will 
certainly lead to death, prompt surgical inter- 
vention is mandatory when the condition is di- 
agnosed, despite the dismal results obtained thus 
far in four cases 6 - 7 reported in the literature. On 
the other hand, if persistent sinus mechanism 
with circulatory arrest is found in a significant 
number of other conditions complicating myo 
cardial infarction, such as sudden pump failure, 
surgical intervention with the purpose of reliev- 
ing hemopericardium could have disastrous con- 
sequences. 

It is hoped that the report of this case will 
stimulate study and report of other conditions 
which might give a false positive diagnosis of 
myocardial rupture. 

Summary 

A case of myocardial rupture secondary to 
acute myocardial infarction is reported. The pa- 
tient survived for about six days following pre- 
sumed rupture. The electrocardiographic findings 
are discussed. 

Recognition of such complication might lead 
to prompt surgical intervention: 

• Electrocardiogram in myocardial rupture 

• Myocardial infarction, complications 

• Myocardial rupture 

• Heart rupture •< 




32 


Illinois Medical Journal 


Categorization Of Hospital Emergency 
Medical Capabilities in Illinois: 

A Statewide Experience 

By David R. Boyd, M.D.C.M., Winifred Ann Pizzano, B.A., Patricia A. Silverstone, 
B.A.Ed. and Teresa L. Romano, B.S.N. 


The categorization of hospital capabilities to 
render effective emergency medical treatment has 
been a subject of increasing interest to the en- 
tire health community. It is anticipated that 
the concept of categorization of hospital emer- 
gency capabilities will be an essential and effec- 
tive step in the process of improving emergency 
medical care across the nation. Of national scope, 
this concept involves the effectiveness of utiliza- 
tion of emergency personnel and facilities, with 
appropriate attention to such elements as quality 
of care, cost, community acceptance, and the 
applicability of categorization to urban and 
rural areas. 1 

The categorization process has taken dif- 
ferent forms in several areas across the nation. 
This variance may be an effective way to re- 
spond to the charge of the American Medical 
Association (AMA) Conference recommenda- 
tions and guidelines for “The Categorization of 
Hospital Emergency Capabilities.” 2 The AMA 
guidelines, established in 1971, concluded with 
a strong recommendation for field testing with 
secondary modified guidelines to be developed 
later, based on the wisdom of experience. 

The State of Illinois has, over the past 
three years, gained considerable experience and 
achieved apparent success in the implementation 
of a hospital categorization program. The de- 

DAVID R. BOYD, M.D.C.M., is Chief of the Division of Emer- 
gency Medical Services and Highway Safety, Illinois Depart- 
ment of Public Health, and Assistant Professor of Surgery, The 
Abraham Lincoln School of Medicine of the University of 
Illinois College of Medicine. WINIFRED ANN PIZZANO, B.A., 
is the Assistant of the Division Chief, Division of Emergency 
Medical Services and Highway Safety, Illinois Department of 
Public Health. PATRICIA A. SILVERSTONE, B.A. Ed., is a former 
Special Assistant for Health Planning and Public Education, 
Division of Emergency Medical Services and Highway Safety, 
Illinois Department of Public Health. TERESA L. ROMANO, 
B.S.N. , is Operations Director for the Division of Emergency 
Medical Services and Highway Safety, Illinois Department of 
Public Health. 


velopment of a trauma care system in 1 971 , 3 ’ 4 
and the initiation of an effort to further expand 
this program into a Total Emergency Medical 
Services System, 5 ' 6 involved initially a functional 
categorization of selected “Trauma Center Hos- 
pitals” for a specific patient group— the critically 
injured— and has been extended to include 261 
acute care hospitals for all aspects of emergency 
medical care. The first Areawide EMS Plan with 
categorization of hospital emergency capability 
in Illinois was reported in this Journal by For- 
kosh. 7 The general approach reported in this 
article was further refined and amplified to 
become a teaching model for the entire state. 

At the time of this writing, the Trauma Pro- 
gram and hospital net are essentially complete 
and the first years’ experience with planning, 
coordinating, and implementing of all Illinois 
general hospitals into some 40 areawide EMS 
plans in compliance with the Illinois Categoriza- 
tion Law (PA 76-1858) has been accomplished. 
Further areawide planning and implementation 
of a wide spectrum of EMS activities is now in 
progress throughout the state, utilizing and 
further supporting this categorized and planned 
areawide approach to the delivery of emergency 
medical services. 

A chronological and programmatic narrative 
of the Illinois experience is the subject of this 
report. 

General Principles 

Categorization of hospital emergency capa- 
bility to comply with bureaucratic regulations 
or restrictive legislative mandates will not, of 
itself, improve the quality of emergency medical 
care. Categorization of hospital emergency medi- 
cal care must be done in relationship to patient 
needs, community capability, and improved re- 
sources utilization. These efforts must be stylized 
to meet the needs of specific emergency patients 


for July , 1974 


33 


which will significantly effect improvement in 
overall medical care. In Illinois, the planning 
process emphasized this important issue and 
required an assessment of the primary care 
capabilities and available transfer mechanisms 
of the following six clinical patient groups in 
each areawide plan: trauma, cardiac (acute 
coronary) , high-risk infant, poison control, drug 
overdose and alcohol detoxification, and psy- 
chiatric emergencies. 

The statewide categorization program in Illi- 
nois was based on the premise of presenting 
the potential benefits to emergency medical 
patients, physicians, nurses, allied health workers, 
and hospitals. Initial awareness of the issues 
and problems of categorization had previously 
been encountered with the functional categoriza- 
tion of some 45 Trauma Centers across the state 
during the preceding year. The Trauma Pro- 
gram was a successful learning model and was 
effective in emphasizing the beneficial aspects 
of hospital categorization and areawide planning 
to an entire statewide health community. 

Categorization in Illinois has allowed for 
hospitals to self-categorize their capability, pro- 
vided that this self-categorization was consistent 
with effective areawide EMS planning. Hospitals 
then had to plan with contiguous hospitals in a 
geographic area, with no deletion of less favored 
hospitals being allowed. To perform this, each 
hospital in an areawide plan had to designate 
one administrator, one physician, and one nurse 
for membership on the Categorization Commit- 
tee to develop the areawide plan (Figure 1) . 
An “area” for EMS planning was geographically 
described to meet functional needs of emer- 
gency medical patients. These coincided fairly 
well with existing and developing Comprehen- 
sive Health Planning “B” planning regions and 
subregions: in fact, they are a leading geographic 
determinant in this and future planning efforts. 

To facilitate planning for the development of 
a “systems approach” to emergency medical 
care, the Illinois Department of Public Health, 
Division of Emergency Medical Services and 
Highway Safety was identified as the govern- 
mental lead agency with overall initiating re- 
sponsibility. 

Illinois has utilized non-ranking terminology 
for its hospital categorization program. By Illi- 
nois law, hospitals are now classified for the 
provision of Comprehensive, Basic or Standby 
emergency medical care. 8 Trauma Center hos- 
pitals have been designated as Regional, Area- 
wide, Local, and “Special” Regional. A func- 


tional comparison of these titles and the AMA 
categorization is shown in Table I. As future 
experience and the real potential of these ef- 
forts is gained, a closer approximation to the 
AMA (or as modified) categorization is anti- 
cipated. 


TABLE I 

HOSPITAL CATEGORIZATION SCHEME 


Illinois Law 
PA 76-1858 

Illinois Trauma 
Program 

AMA Guideline 
Recommendations 


Regional 

I 

Comprehensive 
24 Hour M.D. 
Subspecialties 

Areawide 

II 

Basic 

24 Hour M.D. 

Local 

III 

Standby 

24 Hour R.N. 


IV 


In order to be acceptable, every emergency 
medical plan must have and now has the fol- 
lowing: a strict geographic definition of the area 
of responsibility, working relationships between 
the area hospitals, and a systems description of 
the six clinical patient groups as listed above. 

In a similar fashion, each plan includes the 
other essential EMS subsystems of communica- 
tions, transportation, professional training and 
education, public education, program monitor- 
ing, and evaluation. These activities are now 
being instituted, and area plans are being inte- 
grated into one of nine regional EMS service 
systems. The Illinois concept and definition of 
a medical “region” involves total medical compe- 
tence for all routine as well as the most special 
emergency medical problems. Only very special 
or unique emergency medical problems (spinal 
cord, extensive burn, hyperbaric treatment, etc.) 
need to be removed from a medical “region.” 

The Illinois Experience 

In 1969, the Illinois legislature passed en- 
abling legislation which allowed hospitals to 
self-categorize and to participate in an area- 
wide plan for the delivery of emergency medical 
services. This permissive law was implemented 
in only one area of Illinois (St. Francis Hospital, 
Peoria, and Eureka Hospital, Eureka) . In July 
of 1971, the Illinois Trauma Program became 
operational. This program was not based upon 
a specific law; however, it resulted in the initial 
development of a system for the delivery of 


34 


Illinois Medical Journal 


emergency medical services based on areawide 
and regional medical planning. This program 
aimed at the identification and functional cate- 
gorization of 50 hospital Trauma Centers de- 
dicated to the care of the critically injured 
patient. The functional hospital categories of 
trauma care (Regional, Areawide, and Local) 
were necessarily selective to provide well-identi- 
fied access points to the emergency care essential 
to the life-threatened accident victim. 

The success of the Illinois Trauma Program 
has been due, in part, to the classification of 
treatment centers based on a hospital’s care 
capability and the distribution of selected trauma 
patients by the seriousness of their injuries. In 
this system, patients are secpientially transported 
to more advanced centers for specialized inten- 
sive trauma care as the patients’ clinical needs 
are identified. This basic areawide triage of 
trauma patients has been shown to result in 
better care for the critically injured. 9 It is the 
general impression that trauma patient care is 
now improving in all Trauma Centers and that 
prehospital (primary) transportation and inter- 
hospital (secondary) transporation also are 
improving statewide. In fact, prehospital mobile 
intensive care is now being considered by most 
of the larger communities in Illinois. 

Based on the apparent success of the initial 
Trauma Program in effecting inter-hospital co- 
operation and areawide planning, the Illinois 
Hospital Licensing Board subsequently ruled 
that the permissive categorization law passed 
in 1969 be made mandatory as of July 1, 1975. 
This law provides that all hospitals with emer- 
gency rooms must participate cooperatively in 
an areawide plan to provide medical emergency 
services on a community and areawide basis. 

Areawide Hospital 

Emergency Service Plan Development 

The Division of Emergency Medical Services 
and Highway Safety assumed the responsibility 
of initiating the planning process at the local 
level, and served as a resource (professional, 
technical, staffing and consultation) to the local 
EMS planning committees. In addition, the Di- 
vision continues to serve as a liaison between 
the local planning committees/councils, the 
Illinois Division of Health Facilities ( Hospital 
Licensing) , and Comprehensive Health Plan- 
ning Agencies. 

Distributed in December, 1972, were guide- 
lines, Areaivide Emergency Services: A Manual 
for the Illinois Plan for a Comprehensive Emer- 


gency Care System. This manual includes the 
Emergency Planning Law (PA 76-1858), a de- 
scription of a systems approach to the delivery 
of emergency services, discussions of the EMS 
subsystems, and an identification of the planning 
steps required to comply with PA 76-1858. The 
manual was developed in “loose leaf” form and 
modeled after the AMA guidelines to allow for 
midcourse corrections based on experiences 
gained in field operation. 

Although the Illinois law requires a com- 
prehensive plan for “emergency medical ser- 
vices” including all EMS subsystems, emphasis 
was placed on hospital categorization and the 
development of a basic regionalized medical 
emergency system utilizing current resources and 
building on the existing Trauma Program’s ini- 
tial structure and functional components further 
systems designs were planned for acute coronary, 
high-risk infant, poisoning drug overdose and 
alcohol detoxification, and psychiatric problems. 

The Planning Process 

To initiate this planning process, the Division 
of Emergency Medical Services and Highway 
Safety held a series of 14 regional workshops 
across the state to provide technical and profes- 
sional assistance to local planning groups. All 
appropriate health providers in each geographic 
service area were invited to attend and partic- 
ipate. At the workshops, representatives from 
the Illinois Hospital Association, local (“B”) 
and state (“A”) Comprehensive Health Plan- 
ning Agencies, Illinois Nurses Association, and 
Illinois State Medical Society participated with 
local area physicians, nurses, hospital adminis- 
trators, ambidance operators, etc., to initiate and 
develop their areawide EMS plans. 

Defined Geographic Area 

All area acute care general hospitals with 
emergency rooms or departments met to become 
part of an Areawide Hospital Emergency Service 
Plan. Each plan required a specifically defined 
geographic service area. Participation by pro- 
fessional representatives from contiguous and 
interdependent areas were along the lines of 
established state, regional, and subregional de- 
signs. 

The Illinois Department of Public Health 
and the Hospital Licensing Board interpreted 
the regulations (PA 76-1858) so that in the rural 
Illinois each geographic area would be approxi- 
mately 25 mlies in radius around a “comprehen- 
sive” or “basic” emergency room. This approach 


for July, 1974 


35 


has been effective in downstate Illinois, and 
follows closely the previous Trauma Center area 
planning and hospital designations. 

Within the Chicago metropolitan area, the 
Illinois Department of Public Health recognized 
the 12 functioning Comprehensive Health Plan- 
ning “B” suborganizations established on pre- 
vious service areas and planning agency rela- 
tionships. These 12 planning agencies all related 
to the Chicago area Emergency Service Commis- 
sion for overall planning, inter-area considera- 
tions, and primary plan review. This EMS Com- 
mission was recognized by the Comprehensive 
Health Planning “A” Agency as the responsible 
plan review group for emergency services in the 
Chicago metropolitan area. 

There are, at the present time, some 40 area- 
wide hospital emergency service plans function- 
ing with continuous EMS planning. All of these 
plans essentially include at least one designated 
Trauma Center as the basic or comprehensive 
emergency hospital providing 24-hour physician 
coverage. This hospital Trauma Center is, in 
many areas, the focal point for ongoing EMS 
activities. 

Illinois Hospital Emergency Facility 
Categorization Guidelines 

Categories of emergency services have been 
established which allow hospitals to identify and 
declare the level of emergency services appro- 
priate to their resources. In Illinois, every hos- 
pital with an emergency room must provide 
emergency services in one of the three classifica- 
tions: Comprehensive, Basic, or Standby. The 
essential elements of these emergency service 
classifications are capsulized in Table 2. 

The American Medical Association presently 
endorses four emergency department/room cate- 
gories. 2 The Illinois experience over the past 
year has shown that the identification of at 
least three levels of hospital emergency cate- 
gorization allows for the successful initial devel- 
opment of comprehensive areawide emergency 
medical planning. Within the three categories 
listed above, many hospitals will vary in their 
present overall capability. It is anticipated that 
more uniformity among categorized hospitals 
using existing or modified categorization stan- 
dards will occur with time. 

In Illinois, all hospitals, irrespective of their 
category of emergency services, must have ade- 
quate provision for rendering immediate first 
aid, emergency care, and life support to persons 
requiring such treatment on arrival at the hos- 
pital. In each areawide plan there must be, 


TABLE II 

OUTLINE OF EMERGENCY SERVICE 
CLASSIFICATIONS 


Comprehensive Emergency Treatment Servces 

1. Illinois licensed physician in the emergency 
room 24 hours a day. 

2. Specialties of medicine, surgery, obstetrics, and 
pediatrics on call, and available within minutes, 
24 hours a day. 

3. Additional subspecialties on call and available 
within minutes, 24 hours a day. 

4. Laboratory and X-ray departments staffed 24 
hours a day. 

5. Pharmacy on call within minutes, 24 hours a 
day. 

Basic Emergency Treatment Services 

1. Illinois licensed physician in the emergency 
room 24 hours a day. 

2. Specialties of medicine, surgery, obstetrics, 
and pediatrics on call, and available within 
minutes, 24 hours a day. 

3. Laboratory, X-ray, and pharmacy departments 
on call within minutes. 

Standby Emergency Treatment Services 

1. Registered nurse available at all times. 

2. Illinois licensed physician on call at all times. 


by law, at least one “comprehensive” or “basic” 
designated emergency room. Once a defined geo- 
graphic area is determined, the self-categoriza- 
tions of each of the participating facilities may 
be readjusted as necessary to meet areawide 
needs. With the development of EMS planning 
and categorization, there has been an increase 
in 24 hour physician coverage in downstate 
Illinois. 6 Hospital physician coverage in the 
Chicago area has remained relatively constant 
and area plans are now being further supported 
by a citywide ambulance ordinance that directs 
ambulances with critical patients to compre- 
hensive emergency hospitals. 

Review and Approval of Areawide 
Emergency Service Plans 

The 40 areawide hospital emergency service 
plans were developed after the regional work- 
shops were held across the state, and staff person- 
nel and trauma coordinators served as consul- 
tants to local planning groups, clarifying what 
was required and how to further identify avail- 
able resources. All plans were submitted to ap- 
propriate local Comprehensive Health Planning 
agencies for review and comment. They were 
then passed to the Illinois Department of Public 
Health and further reviewed by the Division of 
Emergency Medical Services and Highway 


36 


Illinois Medical Journal 


EMS PLANNING ORGANIZATION 



Figure 1. The Emergency Medical Services Council and Emergency Medical Services Committee and Subcom- 
mittee structure adapted to local EMS areawide planning. Program initiation and legal authority are impart- 
ed through the Hospital Categorization Subcommittee. 


Safety for professional and technical adeqnacy. 
The Emergency Service Advisory Committee of 
the Hospital Licensing Board made final review 
before the plans were submitted to the Director 
of the Illinois Department of Public Health for 
approval. During the first year (1973) all plans 
received “conditional approval,” and after some 
90 days, finalizing progress reports were resub- 
mitted to the Illinois Dapertment of Public 
Health. 

The local Emergency Medical Service Com- 
mittee is responsible for the development, im- 
plementation, and ongoing evaluation of each 
areawide emergency service plan. The required 
minimum membership of this committee is a 
physician, a nurse, and an administration repre- 
sentative from each participating hospital. In 
addition to the EMS committees, active sub- 
committees have since been formed for com- 
munications, transportation, professional train- 
ing and education, public education, and pro- 
gram evaluation (see Figure 1) . 

Future Expectations of Areawitle 
Planning Process 

The progress made over the past year in 
areawide emergency service planning in Illinois 


has surpassed expectations. The task of develop- 
ing coordinated and upgraded emergency ser- 
vices on a community and areawide basis has 
been initiated. The local planning authority 
for the medical plan has been identified as the 
Emergency Service Council, usually under the 
Comprehensive Health Planning “B” Agency. 

As each EMS planning council/committee 
further develops its plan, more ancillary emer- 
gency service personnel are becoming involved. 
EMS Councils are being integrated into the 
local Comprehensive Health Planning “B” 
Agency activities. The Council itself is made 
up of health providers and consumers and is 
functioning as the overall advisory body to the 
specific area subcommittees on categorization, 
communications, transportation, professional 
training and education, and public education. 

Public Awareness 

All public education subcommittees are now 
working on programs to inform their respective 
communities of the necessity for hospital cate- 
gorization and areawide EMS planning. This 
public education effort will soon be expanded 
to inform the public and to gain support for 
improvements in communciations (“911”), am- 


for July, 1974 


37 


bulance services, and a wide variety of other 
essential emergency medical services. The Illinois 
Division of the American Trauma Society is 
assisting in these public education efforts, and 
state medical, nursing, and hospital associations 
are being asked to lend support. State and local 
health departments will be utilized to provide 
professional and material support to local 
emergency medical services efforts now gaining 
considerable momentum across Illinois. 

Summary 

Categorization is only the first, and most im- 
portant, of the necessary steps to a true regional 
EMS systems implementation. The goal of this 
approach must be the continual upgrading of 
trauma and emergency medical capability across 
the community. This approach can produce 
other benefits including better cost effectiveness 
and improved resource utilization in those com- 
munities which are unnecessarily duplicating 
their efforts, monies, and medical manpower. 

By defining the problem for critically injured 
patients, and by categorizing hospital emergency 
capabilities for this group, significant progress 
has been realized in Illinois, where a total hos- 
pital emergency categorization effort has been 
accomplished. This program was facilitated by 
the statewide experience gained in the trauma 
categorization model. All areawide plans were 
based on self-categorization of each participating 
hospital and consistent with area EMS deficien- 
cies and strengths. Each area plan has attempted 
to initiate a “systems approach” to the six iden- 
tified major clinical patient groups. Equipment 


purchases and other financial allocations were 
then made to support these local EMS plans. 

A major task of public education lies ahead 
for Illinois. One enthusiastic individual, agency, 
or association will not solve this massive health 
problem. It will require a consortium of all 
interested health professionals and agencies 
working together rather than in competition. 
These participants will need to realize that 
individual efforts must be consistent with an 
overall program of improving areawide and 
regional emergency medical services. ^ 

References 

1 . American Hospital Association: Categorization of Hos- 
pital Emergency Services. Report of a Conference. Chi- 
cago, American Hospital Association, 1973. 

2. American Medical Association: Recommendations of 
the Conference on the Guidelines for the Categorization 
of Hospital Emergency Capabilities. Chicago, American 
Medical Association, 1971. 

3. Boyd, D. R., Mains, K. D., and Flashner, B. A.: “Status 
Report: Illinois Statewide Trauma Care System,” IMJ, 
141:56-62, January, 1972. 

4. “A Symposium on the Illinois Trauma Program: A 
Systems Approach to the Care of the Critically In- 
jured.” J. Trauma, 13:275-320, April, 1973. 

5. Boyd, D. R.: “A Preview: A Total Emergency Service 
System for Illinois,” IMJ, 142:486-488, November, 1972. 

6. Boyd, D. R. and Pizzano, W. A.: “Illinois Emergency 
Medical Service System Status Report II (July, 1973),” 
IMJ, 144:210-216, 256, September, 1973. 

7. Forkosh, D. S.: “A Plan for the Organization of Emer- 
gency Services on Chicago’s North Side,” IMJ, 142:209- 
212, September, 1972. 

8. Illinois Public Act 76-1858, signed October, 1966, 
Springfield, Illinois. 

9. Boyd, D. R., Mains, K. D., and Flashner, B. A.: “A 
Systems Approach to Statewide Emergency Medical 
Care,” J. Trauma, 13:276-284, April, 1973. 


Clinics for Crippled Children Listed for August 


Twenty-five clinics for Illinois’ physically handicapped 
children have been scheduled for August by the University 
of Illinois, Division of Services for Crippled Children. The 
Division will conduct 17 general clinics providing diag- 
nostic orthopedic, pediatric, speech and hearing examina- 
tion along with medical social and nursing services. There 
will be six special clinics for children with cardiac con- 
ditions, and two for children with cerebral palsy. Any 
private physician may refer to or bring to a convenient 
clinic any child or children for whom he may want ex- 
amination or consultative services. 


August 

August 

August 

August 

August 

August 

August 

August 

August 

August 

August 

August 

August 

August 

August 


1 Rockford— Rockford Memorial Hospital 
1 Lake County Cardiac— Victory Memorial Hos- 
pital 

6 Belleville— St. Elizabeth’s Hospital 

7 Carlinville— Carlinville Area Hospital 

7 Springfield Pediatric-Neurology-Diocesan Center 

7 Hinsdale— Hinsdale Sanitarium 

8 Sterling— Sterling Community Hospital 
8 Springfield— St. John’s Hospital 

8 Kankakee— St. Mary’s Hospital 

9 Chicago Heights Cardiac— St. James Hospital 

12 Peoria Cardiac— St. Francis Children’s Hospital 

13 Peoria— St. Francis Children’s Hospital 

13 East St. Louis— Christian Welfare Hospital 

14 Champaign-Urbana— McKinley Hospital 

15 Bloomington— Mennonite Hospital 


August 15 Elmhurst Cardiac— Memorial Hospital of Du- 
Page County 

August 20 East St. Louis— Christian Welfare Hospital 
August 20 Rock Island— Moline Public Hospital 
August 21 Chicago Heights— St. James Hospital 
August 23 Evanston— St. Francis Hospital 
August 23 Chicago Heights Cardiac— St. James Hospital 
August 26 Peoria Cardiac— St. Francis Children’s Hospital 
August 27 Peoria— St. Francis Children’s Hospital 
August 28 Springfield Pediatric-Neurology— Diocesan Cen- 
ter 

August 28 Aurora— St. Joseph Mercy Hospital 

The Division of Services for Crippled Children is the 
official state agency established to provide medical, sur- 
gical, corrective and other services and facilities for diag- 
nosis, hospitalization and after-care for children with 
crippling conditions or who are suffering from conditions 
that may lead to crippling. 

In carrying on its program, the Division works coop- 
eratively with local medical societies, hospitals, the Illi- 
nois Children’s Hospital-School, civic and fraternal clubs, 
visiting nurse association, local social and welfare agencies, 
local chapters of the National Foundation and other in- 
terested groups. In all cases the work of the Division is 
intended to extend and supplement, not supplant activi- 
ties of other agencies, either public or private, state or 
local, carried on in behalf of crippled children. 


38 


Illinois Medical Journal 



- §||i 


surgical 
grand rounds 


Edited By John M. Beal, M.D 


Surgical Grand Rounds are held weekly on Tuesday at 5:00 p.m. in the 
Offield Auditorium of the Passavant Pavilion. Patient presentations from North- 
western Memorial and the Veterans Administration Research Hospitals form the 
basis of the discussions. This case report was part of the Surgical Grand Rounds 
of December 4, 1953. 


Hemangiosarcoma of Breast 


Dr. Mitchell Grasseschi: Two cases will be pre- 
sented briefly. First, a 59-year-old Black woman 
was admitted to Wesley Pavilion November, 
1973, with a mass in her left breast. In December 
1972, she had a mass removed from the left 
breast at another hospital. She was told that this 
was a benign tumor. Two months later, she 
noticed tenderness in the same breast and a 
recurrence of a firm mass. There was no change 
observed until four weeks prior to admission 
when she noticed marked increase in the size 
of the mass associated with warmth and dis- 
coloration of the skin of the breast. Past history 
is significant only in that she breast fed her child 
and noted that the left breast was deficient in 
milk compared to the right. 

Physical examination at the time of admission 
was unremarkable except for a large mass in 
the inferior lateral portion of the left breast, 
described by the initial examiners to be ap- 
proximately the size of a grapefruit. Blueish 
discoloration of the skin over the mass was 
noted associated with increased warmth. Admis- 
sion blood count, urinalysis and chest X-ray were 
negative. 

A needle biopsy was performed the day after 
admission and reported as hemangiosarcoma. A 
liver scan showed a suspicious defect in the left 
lobe of the liver. An X-ray skeletal survey was 
negative. Mammograms were obtained. A simple 
mastectomy was performed November 9, 1973. 
Her post operative course was uncomplicated. 

The second case: A 22-year-old white woman 
was admitted December, 1967, with a small, 
fairly movable non-tender nodule in the left 
breast, and a larger tender mass in the right 


breast. Biopsy of both masses was performed. 
The lesion in the left breast mass was reported 
to be fibroadenoma. The right breast mass was 
found to be a hemangiosarcoma. In January, 
1968, a right simple mastectomy was performed. 
She was well until July, 1969, when she noted 
a nodule in her scalp in the occipital region. 
This was excised and microscopic examination 
revealed metastatic hemangiosarcoma. She de- 
veloped numerous subcutaneous recurrences and 
she was admitted for radiation therapy in Jan- 
uary, 1970. At that time she had subcutaneous 
metastasis in the scalp, neck, left axilla and 
recurrence in the mastectomy scar. After colbalt 
therapy, she was well until April, 1970, where 
more subcutaneous nretastases appeared. Chemo- 
therapy was started with cytoxan and Metho- 
trexate. A variety of chemotherapeutic agents 
were used without demonstrable benefit. 

In October, 1970, she was found to have a 
pelvic mass. She was admitted a month later 
with severe abdominal pain. She was taken to 
the operating room and was found to have 
hemangiosarcoma metastatic to both ovaries, with 
hemorrhage and necrosis of the ovaries and 700 
cc. of blood in the peritoneal cavity. A bilateral 
oophorectomy was performed. The liver was 
reported to be normal at laparotomy, but the 
spleen was thought to be enlarged. She recovered 
from this procedure but developed some weak- 
ness in her legs. She subsequently became para- 
plegic and died. 

Dr. Hector Battifora: The excised breast from 
the first patient, the 59-year-old woman, con- 
sisted of several confluent masses of hemorrhagic, 
somewhat necrotic tumor with very poorly cir- 
cumscribed margins. The tumor contained large 


for July , 1974 


79 



Figure 1. H & E stained section from tumor #1. 
Cavernous vascular spaces as well as more solid areas 
are shown, 



Figure 2. H & E stained section from tumor #2. 
Hyperchromatic endothelial cells line irregular vas- 
cular spaces. Innocent appearance of tumor is be- 
trayed hv it’s true malignant potential as evidenced 
hy later development of disseminated metastases. 



Figure 3. Electron micrograph from Case 1. Pleo- 
morphic endothelial cells are shown lining a capillary. 


blood filled lakes. A superficial examination 
with the microscope might lead us to believe 
that we are dealing with a cavernous hemangi- 
oma which is a mistake not infrequently made 
by the inexperienced. However, I think that 
even at low power, one can notice that there 
are grapelike clusters of cells hanging from the 
endothelial surface seemingly due to a local 
excess of cells. This strongly militates against 
a diagnosis of simple hemangioma. On higher 
magnification, one can see that the endothelial 
cells pile up on each other. In addition, there 
are pleomorphic, occasionally bizarre endothelial 
cells. There were also solid areas of growth in 
which the capillaries were very inconspicuous. 
(Figure 1) Changes of this type are enough 
to warrant a diagnosis of henrangiosarcoma re- 
gardless of the tissue source. This is particularly 
true of breast lesions since hemangioma is a 
distinct rarity in the breast. One should be very 
cautious about accepting, prima facie, a diagnosis 
of hemangioma of the breast. In our experience, 
angiosarcoma is a more common tumor than 
hemangioma of the breast. 

The second case, the younger patient, had a 
diffuse enlargement of the breast, a biopsy 
revealed a similar appearance to the previous 
case. (Figure 2) 

Electron microscopy was done in both cases 
revealing that the tumor cells maintained fea- 
tures typical of endothelial cells. (Figure 3) . 

Dr. Mitchell Grasseschi: A review of the litera- 
ture reveals how rare this tumor is. There have 
been only 43 cases reported from 1907 to the 
present. The terms hemangiosarcoma, hemangio- 
blastoma, metastasizing hemangioma and angio- 
sarcoma are synonymous terms. Schmidt (1887) 
is credited with the earliest reported hemangio- 
sarcomas of the breast and described tumors of 
the breast which metastasized without involving 
the lymph nodes. In 1907, Borman reported a 
case of metastasizing hemangioma which was 
histologically benign; however, the patient died 
2(4 years later from multiple metastases. 

From the clinical standpoint, this tumor is 
very rare. It is most frequent among young 
women in the second to third decade of life. 
The age range of the 43 reported patients was 
from 15-82 years with half being 26 years or 
younger. Some have suggested that these tumors 
may be hormone related. Five of the reported 
cases were pregnant at the time of discovery of 
the tumor. The tumor is usually painless, rapidly 
growing and of short duration. The average sur 


40 


Illinois Medical Jownal 


vival after diagnosis is approximately 2i4 years. 
Among the reported cases, only two patients 
survived more than five years, one for seven 
years and one for fourteen years. Hemangio- 
sarcoma has been said to have the worst prog- 
nosis of all breast tumors. The tumor usually 
presents as a deep mass. Occasionally when it 
is superficial, there is bluish discoloration of 
breast. Often there is a reported history of 
trauma. Seven cases were thought initially to be 
a hematoma and were treated expectantly. 
Hemangiosarcoma tends to occur slightly more 
often in the right breast than in the left, al- 
though carcinoma is found slightly more in the 
left breast. They metastasize primarily to the 
lungs, skin, the subcutaneous tissue and the 
bones and rarely to the lymph nodes. Histo- 
logically, these tumors are deceptively benign in 
appearance. Fourteen of the reported cases ini- 
tially had a diagnosis of benign hemangioma. 
As Dr. Battifora mentioned, benign hemangio- 
mas are even more rare than are hemangio- 
sarcomas. 

There does not seem to be any effective treat- 
ment for this problem. Simple mastectomy seems 
to be adequate when the disease is advanced. 
It is interesting to note that of the two patients 
that did survive five years, both had the initial 
diagnosis of malignant hemangiosarcoma and 
both had radical mastectomy. 

Dr. Peter Rosi: There is little to be added to 


the discussion by Dr. Grasseschi. From a review 
of the literature, the most frequently performed 
operation was either a radical or a simple mastec- 
tomy, although wide segmental resections of 
small tumors and subcutaneous mastectomies 
have been reported. The value of post operative 
irradiation has not been established; however, 
Ackerman reported one patient in whom the 
breast angiosarcoma was completely destroyed 
by X-ray irradiation. 

The course of the disease is probably not 
influenced by the surgical procedure, but most 
likely by the biological behavior of the tumor. 
Histologic studies have shown that the greater 
the number of dividing cells per high power 
field, the poorer the prognosis. 

The present prevailing management of angio- 
sarcoma of the breast is a simple mastectomy 
with microscopic examination of the edges of 
the resected specimen for residual malignancy. 
Although the value of post operative irradiation 
and chemotherapy has not been determined, 
they may be, nevertheless, advisable. One of the 
characteristics of hemangiosarcoma of the breast 
has been a high rate of recurrence at the opera- 
tive site. 

Reference 

1. Gulesserian, H. P. and Lawton, R. L.: “Angiosarcoma 

of the Breast.” Cancer , 24:1021, 1969. 



Professional 


protection 


CONTINUOUSLY 


CHICAGO AREA OFFICE: 

T. J. Pandak, J. C. Kunches, L. R. Gannon, and W. G. Prangle, Representatives 
815 Commerce Drive, Suite 102, Oak Brook, Illinois 60521 (312) 325-7314 

SPRINGFIELD OFFICE: W. J. Nattermann, Representative 
426Vi South Fifth Street, Springfield 62701 (217)544-2251 


for July, 1974 


41 





The patient is a 42-year-old white female with 
the chief complaint of recurring attacks and of 
right upper quadrant pain. Physical examination 
revealed tenderness in the right upper quadrant, 
pallor and a prominent spleen. Laboratory work 
revealed a congenital hemolytic anemia. 


What’s your diagnosis? 

1. Carcinoma of the lung 

2. Extramedullary Hematopoiesis 

3. Neurofibroma 

4. Duplication of the Esophagus 



(Answer on page 44) 


42 


Illinois Medical Journal 



new 



For detailed information regarding indications, dosage, 
contraindications and adverse reactions; refer to the man- 
ufacturer’s package insert or brochure. 

Single Chemicals— Drugs not previously known, includ- 
ing new salts. 

Duplicate Single Drugs— Drugs marketed by more than 
one manufacturer. 

Combination Products— Drugs consisting of two or more 
active ingredients. 

New Dosage Forms— Of a previously introduced product. 

The following new drugs have been marketed: 

SINGLE CHEMICALS 


ULCOLAX 

Manufacturer: 
Nonproprietary Name: 
Indications: 

Dosage: 


Supplied: 


Laxative o.t.c. 

Ulmer Pharmacal 

Bisacodyl 

Constipation 

Two to three tablets, taken at 
bedtime or before breakfast, chil- 
dren over 6 one tablet. 

Tablets, 5 mg. 


DOWPEN VK 

Manufacturer: 
Nonproprietary Name: 

Indications: 

Contraindications: 

Dosage: 

Supplied: 


Penicillin Deriv. Rx 

Dow Pharmaceutical 
Phenoxymethyl Penicillin Potas- 
sium 

Infections due to penicillin G 
sensitive organisms 
Hypersensitivity to penicillin 
See package insert 
Tablets, 250 and 500 mg. 


INTROPIN 

Manufacturer: 
Nonproprietary Name: 
Indications: 


Contraindications: 

Dosage: 

Supplied: 


Adrenergic Rx 

Arnar-Stone Laboratories 
Dopamine HC1 

Hemodynamic imbalances pres- 
ent in shock produced by a vari- 
ety of causes. 

Pheochromocytoma 

Follow instructions in package 

insert 

Ampules, 5cc. cc/40 mg. 


NICOLAR 

Manufacturer: 
Nonproprietary Name: 
Indications: 

Contraindications: 

Precautions: 

Dosage: 

Supplied: 


Cholesterol Reducing 
Agent Rx 

Armour Pharmaceutical Comp. 
Niacin 

Hypercholesterolemia and hyper- 
betalipoproteinemia 
Hepatic dysfunction or acute 
peptic ulcer. 

See package insert 
Two to 4 tablets daily 
Tablets, 500 mg. 


QIDAMP 

Manufacturer: 

Nonproprietary Name: 
Indications: 


Contraindications: 

Dosage: 

Supplied: 


Semisynthetic Penicillin Rx 
Mallinckrodt Pharmaceutical 
Prod. Div. 

Ampicillin triliydrate 
Susceptible infections caused by 
Gram-negative and Gram-posi- 
tive organisms. 

Hypersensitivity to penicillin 
See package insert 
Capsules, 250 and 500 mg. am- 
picillin ecj. Powder f. oral sus- 
pension— 125 and 250 mg/5cc 
reconstituted 


HYTINIC 

Manufacturer: 
Nonproprietary Name: 
Indications: 

Dosage: 


Su pplied: 


Hematinic o.t.c. 

Hyrex-Key Pharmaceuticals 
Polysaccharide iron complex 
Iron deficiency anemia 
Capsules— one to two tablets 
daily 

Elixir— Adults, one to tw'o tea- 
spoonfuls daily 

Children, 6-12 one teaspoonful 
daily; 2-6 i/, teaspoonful daily; 
under 2 14 teaspoonsful daily 
Capsules, 150 mg. elemental iron 
Elixir, 5 cc/100 mg. elemental 
iron, alcohol 10% 


METRETON OPIITH. 
SOL 

Manufacturer: 
Nonproprietary Name: 
Indications: 

Contraindications: 


Dosage: 


Supplied: 


Eye preparation Rx 

Schering Corporation 
Prednisolone sod. phosphate 
Steroid-responsive inflammatory 
conditions of the eye. 

Superficial herpes simplex kera- 
titis, viral infections of the cor- 
nea and conjunctiva. Tubercu- 
losis of the eye and fungal 
diseases of the ocular or auricu- 
lar structures. 

Duration varies with type of 
lesion. Eye: One to 2 drops every 
hour during the day and every 
two hours during the night. Re- 
duce dosage as progress occurs. 
Ear: Initial dose 3 to 4 drops 
2 to 3 times daily, reduce grad- 
ually. 

Dropper bottle, 5cc/0.5% 


for July, 1974 


47 


COMBINATION PRODUCTS 


Supplied: 


Capsules 


AMCILL-GC 

Manufacturer: 

Composition: 


Indications: 

Contraindications: 

Precautions: 


Dosage: 

Supplied: 


Penicillin Deriv. Rx 

Parke-Davis 

Dry powder for reconstitution 
Ampicillin trihydrate eq. 3.5 Gm 
Probenecid 1 .0 Gm 

Uncomplicated gonorrhea 
Hypersensitivity to penicillin or 
probenecid 

Do not use in patients with 
blood dyscrasias, uric acid kid- 
ney stones or during acute attack 
of gout. 

Single dose administration 
Bottles containing dry powder 
mixture. 


POXY COMPOUND 65 Analgesic, Non-narcotic Rx 

Manufacturer: Sutcliff & Case 


Composition: 

Indications: 

Contraindications: 

Precautions: 

Dosage: 

Supplied: 


mg. 

Propoxyphene HC1 65 

Aspirin 227 

Phenacetin 162 

Caffeine 32-5 


Relief of mild to moderate pain 
Do not use in children, use with 
circumspection in pregnancy. 
Tolerance has been reported in 
some patients 

One capsule three to four times 
daily. 

Capsules 


ENEMEEZ 

Manufacturer: 

Composition: 


Indications: 

Supplied: 


Enema o.t.c. 

Armour Pharmaceutical Comp. 
100 cc. contain 

Sod. biphosphate 16 Gm 

Sod. phosphate 6 Gm 

Cleansing enema 
Bottles, 4i/2 fl. oz. 


KEY-PLEX Capsules 

Manufacturer: 

Composition: 


Indications: 

Dosage: 


Vitamins and Minerals o.t.c. 
Hyrex-Key Pharmaceuticals 

mg. 

Ascorbic acid 300 

Niacinamide 50 

Thiamine mononitrate 15 

d-Calcium Pantothenate 10 
Riboflavin 10 

Pyridoxine HC1 5 

Magnesium sulfate 70 

Zinc sulfate 80 

Vitamin and mineral deficiencies. 
One capsule daily with meals; 
in severe deficiencies three cap- 
sules. 


PRETTS 

Manufacturer: 

Composition: 


Indications: 

Dosage: 


Supplied: 


Antiobesity 


Preparation 

o.t.c. 

Marion Laboratories 


Alginic acid 

200 mg. 

Sod. carboxymethyl- 


cellulose 

100 mg. 

Sod. bicarbonate 

70 mg. 


Adjunct use in diet control 
Chew 2 to 4 tablets, followed by 
a full glass of water, 30 minutes 
before meals and at bedtime. 
Tablets 


NEW DOSAGE FORMS 


ZARONTIN Syrup 

Manufacturer: 
Nonproprietary Name: 
Indications: 
Contraindications: 
Dosage: 


Supplied: 


Anticonvulsant Rx 

Parke-Davis 
Ethosuximide 
Petit mal epilepsy 
Hypersensitivity to succinimides 
Children 3 to 6 years— one tea- 
spoonful daily; Over 6 years— 
two teaspoonfuls daily 
Syrup, 5cc/250 mg. M 


View Box 

(Continued from page 42) 

DIAGNOSIS: Extramedullary Hematopoiesis — 
This is a rare condition which should be born 
in mind in any case of a paravertebral mass in 
a patient with severe anemia, with or without 
splenomegaly, hepatomegly and gall stones from 
hemolysis (Figure 1). Extramedullary hemato- 
poiesis occurs as a compensatory phenomenon 
in various diseases in which there is inadequate 
production or excessive destruction of blood 
cells; extramedullary sites include the liver, 
spleen, kidney, hila, thymus, adrenal, appendix, 
lymph nodes, dura mater, the broad ligaments, 
prostate, sciatic nerve, breast, and the paraverte- 
bral areas of the thorax. 

The majority of cases are associated with 


congenital hemolytic anemia. It has also been 
found in thalassemia and sickle cell anemia. 

The characteristic roentgenographic finding is 
of multiple masses, smooth or lobulated in con- 
tour and of homogenous density, situated in the 
paravertebral regions, either unilaterally or bi- 
laterally. A presumptive diagnosis usually can 
be made when this roentgenographic finding is 
present in patients with severe anemia and 
splenomegaly. 

The presence of extramedullary hematopoiesis 
within the thorax usually occasions no symptoms, 
although paraplegia has been reported in one 
case. ** 


44 


Illinois Medical Journal 





John R. Tobin, M.D., M.S., Rimgaudas, Nemickas, M.D., 
Patrick J. Scanlon, M.D., John F. Moran, M.S., M.D., 
James V. Talano, M.D., Sarah Johnson, M.D. and 
Rolf M. Gunnar, M.D., M.S./Section of Cardiology, 
Loyola University Stritch School of Medicine 



A 49-year-old female was admitted to the psychiatric service with diagnosis of 
manic-depressive psychosis. She had been on chlorpromazine (Thorazine) , 
thioridazine (Mellaril) and lithium carbonate 300 mg t.i.cl. In recreational ther- 
apy she fell unconscious and was found to be pulseless. Resuscitative effort was 
successful. Rhythm strip taken is shown. 


Questions: 

1. The rhythm strip demonstrates: 

A. Frequent non-conducted premature atrial 
beats. 

B. Second degree A-V heart block (Mobitz 

type I). 

C. Severe sinus arrhythmia. 

D. Sinoatrial block. 

E. None of the above. 


2, The treatment of choice is: 

A. Electrocardiographic monitoring. 

B. Insertion of a temporary transvenous 
pacemaker. 

C. Determination of blood lithium level. 

D. Stopping all medications possible. 

E. All of the above. 

(Answer on page 61) 


for July, 1974 


45 






The Changing Role of Neonatal Nursing 

By Charlyn Slade, R.N., B.S.N./Park Ridge 


new nursing role has been created in the area of perinatal medicine, and 
with it the capacity to save many infants’ lives. Specially trained nurses are 
essential to every neonatal unit. The nursing role in the High-Risk Nursery has 
changed considerably; the old feelings of doing virtually nothing for premature 
infants except feeding and changing diapers have changed. The attitude of 
“don’t handle them and the good ones will survive” is certainly outdated; now 
nursing takes an active part in the care of these critically ill infants. The nurse 
is no longer the physician’s handmaiden; she is a colleague in this setting. In the 
High-Risk Nursery, assuming proper medical supervision, the difference between 
success and failure is the difference between excellent and mediocre nursing care. 


The high-risk nurse must have certain per- 
sonal attributes. Very important is her optimism 
about various therapeutic efforts despite an ap- 
parently dismal outlook. The nurse who feels 
it fruitless to try and save a tiny infant on a 
respirator does not belong in the unit. Calmness 
and composure are essential, since emergency 
situations are frequent and a calm confident 
atmosphere is most reassuring. The nurse also 
must know not only what to do, but have the 
desire to know why it is done. The nurse no 
longer just follows doctors’ orders; she must 
be able to assess problems and initiate or pre- 
pare for the treatment program while awaiting 
the doctors’ instructions and she must anticipate 
his needs. If she functions in this way, the time 
saved may mean the life of an infant. 

The nurse must develop a special feeling for 
babies and generate this feeling to others. This 
feeling consists of an inspiration by, and dedica- 
tion to, the challenges of the care of newborn 
infants. Caring for babies is not routine. Babies 
are fascinating and exciting; they also are in- 
volved and complex. They are not good inform- 
ants so the nurse becomes their interpreter. She 
senses their needs and relays this information to 
the physician. 

The Nurse’s Role 

What exactly is the role of the high-risk nurse? 
Upon receiving an infant to her unit, the nurse 

CHARLYN SLADE, R.N., B.S.N., is 

Head Nurse, High Risk Nursery at 
Lutheran General Hospital, Park Ridge. 


should scrutinize the maternal record with par- 
ticular attention to the length of the first and 
second stages of labor, type of delivery, the anal- 
gesia and anesthesia, the time of rupture of mem- 
branes and the Apgar scores. She shoidd note 
whether any special resuscitative measures were 
needed in the delivery room. All of these things 
will have some bearing on the infant’s adjust- 
ment to extrauterine life. The nurse learns to 
anticipate certain types of behavior from differ- 
ent complications of labor and delivery. 

On admission to the nursery the infant is 
weighed, as all fluids, medications and treatments 
are based on weight. Providing the infant is 
breathing and in no immediate danger of a car- 
dio-respiratory arrest, the next priority is regula- 
tion of temperature. This is done in several ways. 
First, the infant is placed on servo control; a 
probe is placed on the infant’s abdomen and the 
infant then regulates the temperature of the in- 
cubator. Second, a heating coil may be placed in 
i he oxygen humidifier. Then, the infant may be 
placed on a K-pad. Finally, and most important, 
when working with the infant, always work 
through the portholes. If the nurse does not set 
the example of protecting the infant’s warmth, it 
is cpiite likely that no one else will. 

As a member of the team that cares for the in- 
fant, the nurse’s initial assessment should include 
evaluation of general appearance, activity and 
vital signs. Signs of trauma such as cephalhema- 
toma, forcep marks, abrasions or lacerations 
should be noted. Muscle tone is important. Hy- 
potonia may be a result of drug depression or 
cerebral asphyxia or peripheral nerve damage. 

*Presented in part at the “Post Graduate Program in 
Neonatology for Nurses” at Children’s Memorial Hospital, 
November 9, 1972. 



16 


Illinois Medical Journal 


Hypertonia may be a result of cerebral anoxia or 
tetany secondary to hypocalcemia. The nurse 
must be familiar with the normal to recognize 
the abnormal. All of these observations are of 
utmost importance, especially for later compari- 
son. 

Since it is the nurse who handles the infant 
around-the-clock, she is in a position to note 
subtle changes. A nurse’s expertise in the care of 
newborn patients requires an understanding of 
the abnormalities of intrauterine growth patterns 
as they relate to gestational age. An infant’s 
course in the nursery is in large measure deter- 
mined by these factors; the illnesses that develop 
postnatally are often peculiar to a particular type 
of aberrant intrauterine growth pattern. The 
nurse must be adept at assessing gestational age 
by using physical and neurological findings. With 
this skill and a knowledge of maternal factors, 
the nurse can readily recognize a large number 
of high-risk infants and plan their management 
accordingly. For example: infants of diabetic 
mothers are usually large babies even though 
they are premature. A 3300-gm infant born after 
a 34-week gestation may have all the problems 
of prematurity, such as respiratory distress syn- 
drome. On the other hand a term infant weigh- 
ing 1500-gm reflects different in utero problems 
such as placental insufficiency or intrauterine in- 
fection; the trained nurse will be on the alert 
for certain symptoms, such as those of hypogly- 
cemia, which could lead to faster diagnosis and 
treatment. 

The nurse today must be skilled in resuscita- 
tive procedures and be able to recognize quickly 
an infant who is in trouble and respond quickly 
and efficiently. She should be skilled in use of 
the arnbu bag and mask. Often the nurse makes 
the first discovery of serious respiratory dysfunc- 
tion, and she should be able to ascertain that 
therapy is proceeding effectively and without 
jeopardy to the infant. The observations of 
respiratory status made by the nurse are of ut- 
most importance. She should note the infant’s 
color, depth and quality of respirations. Is the 
infant grunting, flaring, retracting? Is his chest 
symmetrical? Are good breath sounds heard? The 
nurse must be familiar with the various respira- 
tors used in a neonatal unit. She should know 
when and why an infant goes on a respirator. 
Once an infant is on a respirator, the nurse must 
watch him even more carefully. Frequent suc- 
tioning and observation of the infant are essen- 
tial; the endotracheal tube must be kept patent. 
The nurses’ observations will help the physician 


in deciding when to wean the infant off the 
respirator. 

Another indication of respiratory status is acid- 
base balance. An understanding of acid-base dis- 
turbances is essential if the nurse is to correlate 
laboratory data with the clinical course of her 
infants and thus assess their progress accurately. 
This is a part of giving full care contributing to 
diagnosis. Appreciation of the rationale of ap- 
propriate therapy is indispensable if the nurse 
is to participate intelligently in its administra- 
tion. Blood gases are routinely done on all in- 
fants receiving oxygen therapy. If high concentra- 
tions of oxygen over an extended period of time 
are necessary, the infant will usually have an 
arterial catheter in place. The ambient oxygen 
concentration should be monitored continuously 
with an electronic analyzer. Charting of the in- 
fant’s appearance and the oxygen concentration 
are essential. 

Electronic monitoring has greatly facilitated 
the detection of cardiovascular and respiratory 
difficulties. These instruments are intended for 
use by skillful personnel; they assist the nurse 
but are not intended to replace her. Severe diffi- 
culty can be detected in the earliest stages by an 
alert nurse who notes cyanosis even though unin- 
terrupted respirations and heart rate have not 
yet tripped alarms of monitors. The nurses’ ob- 
servations lead to action, which in turn reflect 
the quality of care received by the infant. 

Importance of Feeding 

Nutrition is of utmost importance to the sick 
infant. Early feeding minimizes the dangers of 
hypoglycemia, hyperbilirubinemia and excess 
catabolism. Providing the infant can tolerate it, 
oral feedings are started as early as 3-6 hours of 
age. Small quantities of sterile water are offered 
first. The tiny or feeble premature soon demon- 
strates whether or not he can take in by his own 
efforts sufficient food upon which to gain weight. 
Inability to do so or the appearance of cyanosis 
during early attempts at feeding calls for insti- 
tution of gavage feedings. We prefer to use a 
size 3 1/9 French indwelling catheter because these 
sick infants often are in such a delicate respira- 
tory balance that the act of passing the gavage 
tube may induce apnea, cyanosis or bradycardia. 

The observations made by the nurse at feeding 
time are of utmost importance. She needs to 
recognize how the infant acts before the feeding— 
is he awake, active and making sucking motions? 
Does he eat eagerly or does he seem fatigued? 
The first signs of illness can often be detected 

(Continued on page 50) 


jor July, 1974 


47 


there a need 


for a drug 
compendium? 

■ rlri \a 


Adrugcompend 
of the type I envisii 
would fill a definite 
need for the prac 
ing physician. Su( 
compendium wc 
give him all 1 
information n< 
essary for us 
a drug intelligently, and it woulc 


do so in a clear, concise, con- 
venient, objective and balancec 
fashion. 


Government Health Official 


Henry E. Simmons, M.D. 
Deputy Assistant 
Secretary for Health 


What a Compendium Should 
Contain 

I believe the compendium 
should inform the doctor what c 
drug will do, when he should us, 
for what type of patient, for howi 
long, in what dose, what benefitl 
his patient is likely to obtain, th< j 
risks involved, and cross-reactit] 
with other drugs. 

based on the package insert ant i 
have the same legal status. In fc , 
a complete compendium with c<\ 

might even eliminate the neces i 



A drug compendium, or 
preferably compendia, should, 
believe, be private, not federal, 
sponsorship. They should conta 1 
comprehensive listings of drug? 
available for prescribing. They 
should be single, legibly printec 
volumes of reasonable size, up- 
dated quarterly or semiannually 
and completely revised every y« 


Dialogue 


Function of a Compendium 

A compendium should fur 
nish the following information c 
drugs in the followingorder: ind 
tions for use, side effects, advei 
drug reactions, contraindicatioi 
drug interactions, drug dosage 
the dosage forms marketed. Dr| 
prices should not be included b 
cause they vary so widely and 
change rapidly. 

No compendium should si 
forth drugs of choice or discuss 
relative efficacy. Such questior 
must be left for the practicing p 
sician to decide, whether on the 
basis of the medical literature, 
own clinical experience, advice 
colleagues, information supplie 
by manufacturers, and so on. 

Nor should a compendiun 
undertake to educate the docto 
how to use drugs. Rather, it mu 
be a reference source designed 
marily to refresh his memory a: 
drugs he may not use regularly 


! package insert in many in- 
:es. This would constitute a 
a.antial saving for the manu- 
rer. 

By a complete compendium, 
not mean a volume of prohibi- 
s ize. You don’t need a book 
r ribing 25,000 products with 
lormous amount of repetition, 
ter, drugs should be arranged 
• ass. Mutually applicable infor- 
nn would be provided, along 
brief discussions pinpointing 
rences in specific drugs of 
iclass. Listings would be cross- 
1, :ed in a useful way. 

ir Available Documents as 
lies of Information 

Existing references such as 
land the AMA Drug Evaluation 
i bviously useful but they are 
>nplete. Either they are not 
ii-referenced by generic name 

! lo not group drugs with simi- 
laracteristics, or they do not 
I the available and legally 

( eted drugs. And some of 
! omitted may be very useful. 

lid in no way imply control over 

! iractitioner’s prerogatives. 

Another Compendium? 

A practicable, single-volume 
tpendium cannot, nor is it 
cssary to, include all drugs on 
market today. From my prac- 
of internal medicine for some 
fears, my experience as a con- 
iint, and as a faculty member 
3ur or five medical schools, I 
i d estimate that a doctor uses 
30 to 35 drugs regularly. The 

) l Physicians’ Desk Reference, 
ientally, contained about 
0 entries. 

As to whether there should be 
deral compendium, in my opin- 
as stated earlier, the answer is 
—there should not be one. The 
>osal assumes that existing 
.pendia are inadequate. We’re 
sure of that at all. Whatever its 
ejections, the present drug 
rmation system in the U.S. is 
i, multifaceted, pluralistic and 
nsive. Good compendia exist, 
ell as other ample sources on 
l therapy, ranging from journal 
ature through AMA Drug Evalu- 
'i to company materials. Not 
hysicians may use such 
"ces as often or as well as they 
Jld, but that is the fault of the 
i, not of the sources. 

In any event, rather than pro- 


On the other hand, drugs made by 
more than one supplier, tetracy- 
cline for example, may be fully 
described a dozen times in the 
same book. 

While perhaps PDR could be 
rearranged and cross-indexed with 
generics included, and while the 
AMA Drug Evaluation might also 
be modified and expanded, I am 
not sure that the end result would 
have all the attributes required for 
a useful compendium. At the same 
time, you would run the risk of 
amassing a voluminous and un- 
wieldy tome. 

Should Editorial Comments 
Accompany the Listings? 

Subjective judgments, in my 
opinion, have no place in a com- 
pendium. However, if there is sub- 
stantial evidence based on a sound 
body of science concerning rela- 
tive efficacy of several drugs, cer- 
tainly that information should be 
included. The committee of experts 
compiling and editing a particular 
section would also have to assess 


and indicate instances where a 
meaningful difference between 
drugs is pertinent. 

Sponsorship, Compilation 
and Editing 

Producing a book like this 
would undoubtedly be difficult and 
demanding. It would obviously take 
a great deal of talent and exper- 
tise, and would require a varied 
and experienced group, ranging 
from writers and editors to highly 
skilled clinicians and pharmacolo- 
gists. Style, format and clarity of 
language would play an important 
part in determining the usefulness 
of the book. And it should be up- 
dated periodically and completely 
revised annually. 

I have no opinion whether the 
government or the private sector 
should sponsorand/or finance the 
compendium. What is most im- 
portant is that the compendium be 
an authoritative, objective and 
useful source of information for 
the doctor to have at hand as a 
ready reference. 


duce another book, it makes much 
more sense to work on improving 
existing compendia, and perhaps 
they could, as knowledge ad- 
vances, include more accumulated 
clinical data and experience, and 
more information on drug interac- 
tions and adverse reactions. 

Implications of a Federal 
Compendium 

Take a hard look at the impli- 
cations of a federal compendium. 

It would have the force of law, vir- 
tually dictating what drugs to use 
and how to use them. In effect, it 
would be a regulatory document 
with legal or quasi-legal status, 
posing medical/ legal problems 
similar to those the doctor may 
now encounter if and when he de- 
parts from the provisions of the 
package insert. A compendium 
under federal aegis would tend to 
restrict decisions on drug therapy 
to one orthodox level — a most 
dangerous trend for medicine. 

New Compendium — A Medical 
Option 

I detect no ground swell of 
initiative or support whatsoever for 
a federal compendium — or, for 
that matter, for a new compendium 
of any type. A 1969 PMA survey 
conducted by Opinion Research 
Corporation found that only 15 per 


cent of those physicians inter- 
viewed felt a new compendium was 
needed. And a iarge majority did 
not favor the involvement of the 
federal government if one were to 
be created, preferring instead a 
nongovernmental consortium. 

Even if we come to a time 
when the medical profession itself 
optsfora new kind of compendium, 
it should be handled and financed, 
ideally, outside both government 
and industry. Final review and edi- 
torial authority could be delegated, 
say, to specialty bodies and medi- 
cal societies— but above all, not 
the government. 

Surely the health care system 
in the United States has far more 
vital matters to consider than the 
extensive cost and effort that 
would have to go into the prepara- 
tion and maintenance of a new, 
monolithic compendium, and 
especially one bearing the impri- 
matur of the federal government. 


Opinion & Dialogue 

What is your opinion, doctor? We 
would welcome your comments. 


The Pharmaceutical 
Manufacturers Association 
1155 Fifteenth Street, N.W. 
Washington, D.C. 20005 




The Changing Role of Neonatal Nursing 

(Continued from page 47) 


by the nurse at feeding: they include gastric 
residual from previous feed, abdominal disten- 
tion, vomiting, refusing to feed, lethargy or 
cyanosis with feedings. Since the nurse is with 
the infant around-the-clock, she can make these 
observations more readily than anyone else. 

In the very small or ill infant, early feeding is 
best accomplished by the intravenous route. 
Fluid and electrolyte balance are very important 
to the neonate. Usually no parenteral electrolytes 
are necessary for the first 24-48 hours. The nurse 
should know the fluid requirements of infants. 
Regulation of IV’s is done with an infusion 
pump. We use both the Holter and Ivac. The 
pump insures a constant flow and prevents over- 
hydration of the infant, providing a trained 
nurse is regulating it. The nurse has a large re- 
sponsibility to making sure that the IV— whether 
in an umbilical vessel or peripheral one— remains 
patent and functiontal. This may be the infant’s 
life-line. In the very small babies even a small in- 
filtrate of IV fluid into subcutaneous tissue may 
cause sloughing which could lead to infection. 
The nurse must, therefore, check the site of in- 
fusion frequently. 

The nurse is also involved in the transport of 
infants to her center. Responsibility for that in- 
fant begins when the infant is accepted. The 
nurse needs to get a full report from the refer- 
ring hospital and also inform them what to send 
with the infant. Some hospitals send trained 
nurses out to pick up the infant. Everything 
should be set up so that once the infant arrives 
treatment can begin immediately. 

Another major role of the nurse is working 
with parents. The old concept of not letting 
parents in the nursery and just allowing them to 
look through glass windows is obsolete. Parents 
should be encouraged to come into the nursery 
and to do as much for their infant as possible, 


even if this means just touching the infant 
through the portholes of the isolette. The nurse 
must realize that this is somewhat of a shock to 
parents; their baby is not the normal one they 
expected. The many wires attached to the infant, 
and equipment surrounding the infant may 
frighten the mother, and she may be under- 
standably unable to focus on her infant. An hon- 
est simple explanation of what is going on with 
her infant is often reassuring to the mother. As 
the infant progresses, it is important to teach 
the mother to care for her infant and to en- 
courage her to become a part of the team. 

The nurse also may be involved in a follow-up 
clinic. Nurses take pride in seeing the later prod- 
ucts of the tiny patients they cared for in earlier 
months. Much can be gained from the follow-up 
of these high-risk infants. 

What about the high-risk nurse of the future? 
She will continue to grow professionally along 
with the high-risk nurseries and neonatologists. 
She will learn new skills including endotracheal 
intubation. Nurses will continue to be involved 
in the actual transport of infants and will assume 
increasing responsibility in this area. The nurse 
is now an integral part of the “High-Risk Team.” 
Now doctors and nurses work together to give 
each infant the best possible chance for a mean- 
ingful existence. ◄ 

Bibliography 

1. Babson, S. G., and Benson, R. C.: Management of 
High-Risk Pregnancy and Intensive Care of the Ne- 
onate, 2nd ed., St. Louis, 1971, C. V. Mosby Co. 

2. Korones, S. B.: High-Risk Newborn Infants— The 

Basis for Intensive Nursing Care, St. Louis, 1972, C. 
V. Mosby Co. 

3. Minott, W.: “Nurses Key Functions in Operation of 
Intensive Special-Care Nursery.” Hospital Topics, 65- 
67, Nov., 1971. 

4. Silverman, W. A.: Dunham’s Premature Infants, 1955, 
Paul B. Hoeber, Inc. 


It's a Two-Way Street 

Our advertisers help bring you the ILLINOIS MEDICAL JOURNAL each month. Show 
them your appreciation by mentioning their ads and buying their products. 

Ask those who don’t advertise why. You support them. They should support your maga- 
zine. 


50 


Illinois Medical Journal 


7 ) actin' & 

Dr. Jirka Wins Two-Year Term 
As AM A Trustee 


Frank J. Jirka, Jr., M.D., River Forest, was elected to a two-year term as an AMA Trustee during the 
closing session of the Annual AMA Convention held in Chicago, June 23-27. 

Dr. Jirka, a urologist, is an ISMS Past President; delegate to the 
AMA; and former ISMS Trustee. 

Eleven candidates vied for the six positions available on the 
AMA Board of Trustees. 

Also during the AMA meeting, the American Association of 
Medical Society Executives met at its’ annual meeting and 
elected David Meister, Jr., Peoria to the Board of Directors. 

Mr. Meister is the county executive for Peoria and Tazwell 
counties. He has served the counties for many years and is 
active on the AAMSE committees for continuing education. 


CME WORKSHOPS PLANNED FOR THIS FALL-Continuing Medical Education work- 
shops will be held October 4-6, 1974, in Chicago and St. Louis. Objectives 
of the workshops are to learn (1) effective methods for involving colleagues 
in planning and conducting in-hospital CME programs; (2) group tech- 
niques for problem-solving; and (3) methods for analyzing the learning 
needs of hospital colleagues. 

The workshops are planned by the Illinois Council on Continuing Medi- 
cal Education Committee on CME Workshops. The content and approach 
for the workshop are based on a survey of Illinois hospital CME planners. 
Fourteen hours of AMA Category I credit may be earned. 

For full details, write: Illinois Council on Continuing Medical Education, 
360 N. Michigan Ave., Chicago, 60601. 

U. OF I. GETS APPROVAL FOR HOSPITAL— The Illinois Board of Higher Education re- 
cently approved the University of Illinois’ plans to construct a $60 million 
university hospital on the West Side of Chicago. 

The proposed hospital would replace the existing 500-bed university 
hospital. The project also needs the approval of the General Assembly. 

PHYSICIANS IN THE NEWS— Robert A. Miller, M.D., pediatric cardiologist, has been ap- 
pointed Chairman of the Department of Pediatrics of Cook County Hos- 
pital, Chicago. 

William F. Hejna, M.D., Dean, Rush Medical College and Vice President 
for Medical Affairs at Rush-Presbvterian-St Luke’s Medical Center, has 
been elected President of the State of Illinois Council of Medical Deans. 

The new Dean of the Abraham Lincoln School of Medicine, University 
of Illinois College of Medicine, is Bernard Sigel, M.D. Dr. Sigel, presently 
Dean of the Medical College of Pennsylvania, will assume his new position 
September 1. 



Dr. Jirka 


for July, 1974 


51 


ISMS Trustee Warren Tuttle, M.D., Harrisburg, was one of the five 
University of Illinois College of Medicine graduates to receive Alumni of 
the Year Awards. Dr. Tuttle was cited for his service to medical organiza- 
tions. 

J. Philip Ambuel, M.D., is the new Medical Director of Ambulatory 
Services at The Children’s Memorial Hospital, Chicago. 

Lloyd M. Nyhus, M.D., Professor and Head of the Department of Sur- 
gery, Abraham Lincoln School of Medicine, University of Illinois, Chicago, 
was recently installed as President of the Society for Surgery of the 
Alimentary Tract. 

Beg your pardon— last month’s Doctor’s News cited Joseph L. Bordenave, 
M.D., as a recent recipient of a Masters degree in education. This was in 
error, as Dean Bordeaux, M.D., Peoria, earned this post graduate degree 
from Bradley University. 


ISMS Past President Thomsen Honored 
For 40 Years of Service 



In commemoration of 40 years of medical practice, 
over 800 patients, relatives, associates and friends in 
general gathered May 31, 1974, to honor Philip G. 
Thomsen, M.D., Dolton, at a testimonial dinner. 

In attendance were Congressman Edward Der- 
winski, former Governor Ogilvie, State Rep. Tom 
Miller and officials of several south suburban com- 
munities as well as the staffs of clinics and hospitals. 
Congratulatory wires were received from many who 
could not attend. Both Vice President Gerald Ford 
and President Nixon sent letters of congratulations. 

Dr. Thomsen has been very active in organized 
medicine having served as President of the Illinois 
State Medical Society and President of the Illinois 
Foundation for Medical Care. He presently serves 
as ISMS Trustee from the Third District. 



Dr. Baranov Mr. Stagl 


Lester J. Baranov, M.D., Honored 

The physicians of Bethesda Hospital, Chicago, paid 
tribute to Lester J. Baranov, M.D., at a gala State 
of Israel Bond testimonial dinner last month. Dr. 
Baranov was cited for his devoted support of Israel’s 
economic development through the State of Israel 
Bond campaign and for his dedication as a physician. 

Guest speaker at the affair was Robert Mayer 
Evans, foreign correspondent and former Moscow 
Bureau Chief for CBS news. 

Dr. Baranov, a graduate of the Chicago Medical 
School, was appointed National Surgeon by the Jew- 
ish War Veterans of America in 1970. 

New Head Named For McGaw 
Medical Center of NU 

John M. Stagl, President of Northwestern Memorial 
Hospital, has been named Executive Vice President 
of the McGaw Medical Center of Northwestern Uni- 
versity. The position became vacant upon the recent 
death of Ray E. Brown. 

Mr. Stagl is a former Trustee of the Illinois Hos- 
pital Association, and is Secretary of the Illinois 
Regional Medical Program and Trustee of the Ameri- 
can Hospital Association. 


52 


Illinois Medical Journal 




Editorials 



Angina Pectoris 


Angina pectoris, a well-known cardiac symp- 
tom, is usually ascribed to myocardial ischemia 
secondary to coronary atherosclerosis. Although 
one or more of the coronary arteries is narrowed 
or obstructed, it functions properly so long as the 
individual is resting or calm. It is during exercise, 
excitement or, perhaps, following a heavy meal 
that the blood flow is not adequate. One victim 
in five goes on to develop coronary thrombosis or 
myocardial infarction. 

The chest pain or feeling of pressure, constric- 
tion, or tightness may last seconds or minutes. 
Nitroglycerin usually brings relief to victims who 
have only one or two attacks a day. Those with 
frequent attacks or nocturnal angina should have 
coronary angiography and aortocoronary bypass 
surgery. As a rule, the more severe the angina, 
the better the surgical prospects. Surgical inter- 
vention is not recommended when only one ves- 
sel is diseased. Angiography requires considerable 
skill and should be done by technicians and sur- 
geons who do several of these operations every 
week. Selecting patients for saphenous bypass 
surgery is not simple. Furthermore several years 
must elapse before long-term results can be eval- 
uated. Not all bypass grafts remain open. In fact, 
15 to 30% of these close. The operative mortality 
averages six per cent. 

The medical treatment of ordinary angina in- 
cludes nitroglycerin, which not only relieves pain, 
but is an excellent drug to prevent predictable 
pain (after meals, or during unpleasant discus- 
sions and sexual intercourse) . Longer-acting 
drugs, such as isosorbide dinitrate (Isordil) , ery- 
thrityl tetranitrate (Cardilate) or pentaerythritol 
tetranitrate (Peritrate) also may be helpful. 
Propranolol (Inderal) is useful because it lessens 
the oxygen needs of the cardiac muscle. Walking 
a distance shorter than that required to induce 
pain has a favorable effect on the cardiac con- 
traction. 


Upper abdominal disorders such as hiatal her- 
nia, peptic ulcer, gallbladder disease, recurrent 
pancreatic edema often initiate anginal pain at 
rest in those who also have exertion angina. Re- 
flexes from the abdomen can be very strong and 
correcting the culprit may be most helpful. The 
wearing of an abdominal support has long been 
forgotten, but it may lessen angina in an obese 
individual. 

There are many variations of angina pectoris. 
Much has been written on the Prinzmetal variant 
and with the development of bypass surgery for 
coronary artery disease, the identification of pa- 
tients with Prinzmetal angina pectoris became 
more than just acedemic interest. However, iden- 
tification is not easy because there is no precise 
correlation between the clinical picture of Prinz- 
metal angina and the Underlying anatomy. 

Prinzmetal and his group described the variant 
as 1) Chest pain begins most commonly at rest 
(often during deep dreamless sleep) or with or- 
dinary activity and not with exertion. 2) During 
episodes of pain, there is transitory ST eleva- 
tion on the electrocardiogram which is otherwise 
normal at rest. 3) Exercise tests are frequently 
negative. 4) A focal lesion is found in a single 
vessel only. 5) During pain, arrhythmias, such as 
ventricular tachycardia or conduction disorders 
are frequently noted. 6) Myocardial infarction 
often occurs in the area of the heart correspond- 
ing to the ST segment elevation. 7) Finally, there 
is no subsequent serum enzyme elevation. 

There is little coronary atherosclerosis, mini- 
mal plaquing with no areas of narrowing greater 
than 20%, or entirely normal coronary arteries. 
Perhaps the coronary artery spasms are respon- 
sible for the distress. In fact, well-defined spasms 
have been observed during angiography. Chest 
pain also has been brought on or aggravated by 

(Continued on page 62) 


for July , 1974 


53 



As I Saw It In Springfield 


One persistent thought emerged during and 
after the ISMS LEGISLATION DAY in Spring- 
field, and it overwhelms every other impression 
and expression from the day: WE MUST BE- 
COME INVOLVED! And it is imperative that 
we convince our physician husbands to take the 
time not only to be informed but to let their 
voices be heard LOUD AND CLEAR IN GOV- 
ERNMENT! 

Yes, I’m well aware how busy they are and 
that they must take care of the sick and wounded 
first . . . but bills are being enacted every ses- 
sion that limit their effectiveness in practicing 
medicine. These new laws tend to add more and 
more paper work plus more restrictions on the 
“art of medicine.” 

Listening to the governor, I thought to my- 
self “He really doesn’t understand the practice 
of medicine nor does he realize what is being 
done to medicine through all the limitations 
being imposed on physicians through bureau- 
cies.” 

Each speaker, even though some were elo- 
quent, made the picture even more clear! POLI- 


TICS IS NOT SOMETHING WE CAN LEAVE 
TO THE PROFESSIONAL POLITICIANS. We 
as doctors’ wives must take an active interest 
and do something to encourage good legislation. 
We can be effective! It is so easy to excuse our 
lack of action because we are busy . . . but we 
no longer can afford to neglect our responsibility. 

Won’t you please read the ISMS Action Report 
and On the Legislative Scene ? They are sent to 
you without charge. If you are not already re- 
ceiving them, write the ISMS office to put you 
on the mailing list. NOW, after you read the 
issues currently before the legislature. DO 
WRITE YOUR REPRESENTATIVES AND 
SENATORS TO EXPRESS YOUR VIEWS. 
Let them know how you feel, how you want 
them to represent you! They do read their mail 
and letters are effective. When it comes time to 
vote, support those who are friends of medicine 
and who can best represent us and do what 
is right for our state and our nation. 

Millie Vickery, President-Elect 
WA/ISMS 


District Meetings 


September 

10 

District 4 

Rock Island 

Place to be announced 

September 

17 

District 5 & 6 

Pekin 

Pekin Country Club 

September 

19 

District 1 & 2 

Elgin 

Holiday Inn 

September 

27 

District 11 

Joliet 

Place to be announced 


5J 


Illinois Medical Journal 


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T he Womans Auxiliary to the Illinois State Medical Society are selling 
these “Mouth-to-Mouth Resuscitation' plaques. Inquiries in obtaining these 
plaques should be directed to: Mrs. Paul E. Wochos, WA/ISMS Safety 
Chairman, 349 S. Elmwood Lane, Plum Grove Estates, Palatine, III. 60067. 


for July, 1974 


55 




ISMS Guide to 
Continuing Medical Education 

Compiled for Illinois physicians by the 
ILLINOIS COUNCIL ON CONTINUING MEDICAL EDUCATION 
360 No. Michigan Ave. • Chicago, IL 60601 • (312) 782-1654 


CONTINUING 



Items for this Calendar must be received 90 days prior to the event. Those received earlier may appear in up to three 
monthly issues. 

If your organization’s CME activities are not listed— please contact us. To avoid possible conflicts, you’re invited also 
to consult our pie of future events. 

WARNING! Items for this Calendar come from many sources, often far in advance of the publication date. Some- 
times, cancellations or changes in date, place or time occur too late to be corrected before publication. You are urged 
to contact the sponsoring organization to confirm information given below. 


AUGUST 


Emergency Care 

EMERGENCY MEDICAL CARE 

For: All physicians. August 12-16, 1974; Wisconsin 
Cntr., Madison, Wis. Sponsor, contact: Univ. of Wis- 
consin, Dept, of Continuing Med. Educ., 610 N. Wal- 
nut St., Madison, Wl 53706. 

Family Medicine 

SPECIALTY REVIEW COURSE FOR FAMILY MEDICINE 
For: Family Physicians. lOVi-day course, August 12- 
23, 1974, Chicago. Hrs. of Instr.: 98. CME Credit: 
AMA Category 1. Fee: $300. Reg. Limit: 150. Spon- 
sor, contact: Cook County Grad. Sch. of Med., 707 
S. Wood St., Chicago, IL 60612. 

General Interest 

PAS & MAP TUTORIAL SESSION 
For: Physicians, Hosp. Admin., Allied Health. August 
7-8, 1974, Ann Arbor, Mich. Hrs. of Instr.: 12. CME 
Credit: AMA Category 1. Fee: $110 (1-4 persons, if 
at least 2 physicians). Reg. Limit: 75. Sponsor, con- 
tact: Commission on Professional & Hosp. Activities, 
1968 Green Rd., Ann Arbor, Ml 48105. 

Orthopaedics 

SPECIALTY REVIEW COURSE IN ORTHOPAEDICS 

For: Specialists. 6 >/ 2 -day course, August 25-31, 1974, 
Chicago. Hrs. of Instr.: 60. CME Credit: AMA Cate- 
gory 1. Fee: $200. Reg. Limit: 60. Sponsor, con- 
tact: Cook County Grad. Sch. of Med., 707 S. Wood 
St., Chicago, IL 60612. 

Psychiatry 

WINNEBAGO SYMPOSIUM FOR 
GENERAL PRACTITIONERS 

For: Family Physicians. August 22, 1974, The Pioneer 
Inn, Oshkosh, Wis. Hrs. of Instr.: 6 . CME Credit: 
AMA Category 1. Fee: $15. Reg. Limit: 60. Sponsor, 
contact: Winnebago State Hospital, Box H, Winnebago, 
Wl 54985. 

Sports Medicine 

SPORTS MEDICINE 

For: Family Physicians, Allied Health. One-day work- 
shop, August 28, 1974, Indianapolis. Hrs. of Instr.: 
7. CME Credit: AMA Category 1. Sponsor, contact: 
Mr. John Roscoe, Program Co-ord., Indiana Univ. Sch. 
of Med., 1100 W. Michigan St., Indianapolis, IN 


SEPTEMBER 


Alcoholism 

ALCOHOLISM 

For: All Physicians, Allied Health. Weekly medical 
education seminar, Sept. 24, 1974, 11:30 AM, Me- 
morial Hospital of DuPage County, Elmhurst, III. 
Speaker: Herbert Neuhaus, M.D., Dept, of Public 
Health Hosp , Chicago. Hrs. of Instr.: 1. CME Credit: 
AMA Category 1. Sponsor, contact: John H. Huss, 
M.D., DME, Memorial Hospital of DuPage County! 
Avon Rd. & Schiller St., Elmhurst, IL 60126 


Anesthesiology 

CLINICAL ANESTHESIA PRACTICE— COURSE I 

For: All Physicians. 1-month course, Sept. 30-0ct. 
29, 1974, Chicago. Hrs. of Instr.: 176 approx. CME 
Credit: AMA Category 1 Fee: $400. Sponsor, contact: 
Cook County Grad. Sch. of Med., 707 S. Wood St., 
Chicago, IL 60612. 


Cardiology 

CARDIOVASCULAR DISEASES 

For: All physicians. Lecture, group discussion, Sept. 
13, 10 AM, S.R. Forkosh Hospital; Sept. 13, 6 PM. 
Lincolnwood Hyatt House; Sept. 14, 10 AM, Bethany 
Methodist Hospital. Speaker: G. T. Gau, M.D., Mayo 
Clinic. CME Credit: 5 hrs. AMA Category 1. Fee: $10 
(non-staff, for dinner) Reg. Deadline: Sept. 9, 1974. 
Sponsor: FAB 3 -CME. Contact: Mr. S. Plotner, S. R. 
Forkosh Hospital, 2544 W. Montrose, Chicago, IL 
60618; (312) 267-2200. 

INTERNATIONAL SYMPOSIUM ON 
EPIDEMIOLOGY OF HYPERTENSION 

For: All Physicians, Epidemiologists. 3 day symposium, 
Sept. 18-20, 1974, Sheraton-Blackstone Hotel, Chi- 
cago. Fee: $150 ($75 students). Sponsor, contact: 
Helen Heck, Chicago Heart Association, 22 W. Madison 
St., Chicago, IL 60602. 

INTERMEDIATE CARDIOLOGY 

For: All Physicians. 41 / 2 -day course, Sept. 23-27, 
1974, Chicago. Hrs. of Instr.: 32 approx. CME Cred- 
it: AMA Category 1. Fee: $175. Sponsor, contact: 
Cook County Grad. Sch. of Med., 707 S. Wood St., 
Chicago, IL 60612. 

ECHOCARDIOGRAPHY WORKSHOP 

For: Specialists. 4-day course, Sept. 30-Oct. 3, 1974, 
Indianapolis. Hrs. of Instr.: 28 CME Credit: AMA 
Category 1. Reg. Limit: 50. Sponsor, contact: Mr. 
John Roscoe, Program Co-ord., Indiana Univ. Sch. 
of Med., 1100 W. Michigan, Indianapolis 46202. 


Family Medicine 

FIFTH FAMILY MEDICINE REVIEW 

For: Family Physicians, Osteopaths. Symposium, Sept. 
15-21, 1974, Univ. of Kentucky Medical Cntr., Lex- 
ington, Ky. CME Credit: 50 hrs. AAFP; 50 hrs. AMA 
Category 1. Fee: $195. Reg. Limit: 250. Sponsor, 
contact: Ofc. of Cont. Educ., College of Med., 
Univ. of Kentucky, Lexington, KY 40506. 


Gastroenterology 

UPPER GASTROINTESTINAL ENDOSCOPY 

For: Specialists. 2-week course, Sept. 9-20, 1974, 
Chicago. Hrs. of Instr.: 40 approx. CME Credit: AMA 
Category 1. Fee: $350. Sponsor, contact: Cook County 
Grad. Sch. Med., 707 S. Wood St., Chicago 60612. 

FIBEROPTIC COLONOSCOPY 

For: All Physicians. 3-day course, Sept. 11-13, 1974, 
Chicago. Hrs. of Instr.: 21 approx. CME Credit: AMA 
Category 1. Fee: $250. Sponsor, contact: Cook County 
Grad. Sch. Med., 707 S. Wood St., Chicago 60612. 

FIBEROPTIC ESOPHAGOGASTRIC ENDOSCOPY 

For: Specialists. 3-day course, Sept. 16-18, 1974, 
Chicago. Hrs. of Instr.: 20 approx. CME Credit: AMA 
Category 1. Fee: $250 Sponsor, contact: Cook County 
Grad. Sch. Med., 707 S. Wood St., Chicago 60612. 


Internal Medicine 

REVIEW COURSE IN RHEUMATOLOGY 

For: Family Physicians. 1-week course. Sept. 9-13, 
1974, Chicago. Hrs. of Instr.: 35 approx. CME Cred- 
it: AMA Category 1. Fee: $200. Sponsor, contact: Cook 
County Grad. Sch. of Med., 707 S. Wood St., Chi- 
cago, IL 60612. 

REVIEW COURSE IN PULMONARY 

For: Family Physicians. 1-week course, Sept. 9-13, 
1974, Chicago. Hrs. of InStr.: 35 approx. CME Cred- 
it: AMA Category 1. Fee: $200. Sponsor, contact: 
Cook County Grad. Sch. of Med., 707 S. Wood St., 
Chicago, IL 60612. 

RECENT CONCEPTS IN DIABETIC MANAGEMENT 

For: All Physicians, Allied Health. Weekly medical 
education seminar, Sept. 10, 1974, 11:30 AM, Me- 
morial Hospital of DuPage County, Elmhurst, III. 
Speaker: Ann M. Lawrence, M.D., Univ. of Chicago. 
Hrs. of Instr.: 1. CME Credit: AMA Category 1. 
Sponsor, contact: John H. Huss, M.D., DME, Me- 
morial Hospital of DuPage County, Avon Rd & 

Schiller St. , Elmhurst, IL 60126. 

ENDOCRINOLOGY 

For: Internists. 3-day course, Sept. 11-13, 1974, 

Hilton Hotel, Indianapolis. HrS. of Instr.: 18. CME 
Credit: AMA Category 1. Sponsor, contact: American 
Coll. Physicians, 4200 Pine St., Philadelphia 19104. 

REVIEW COURSE IN HEMATOLOGY 

For: Family Physicians. 1-week course, Sept. 30-0ct. 
4, 1974, Chicago. Hrs. of Instr.: 35 approx. CME 

Credit: AMA Category 1 Fee: $200. Sponsor, con- 

tact: Cook County G'rad. Sch. of Med., 707 S. Wood 
St., Chicago, IL 60612. 

REVIEW COURSE IN INFECTIOUS DISEASES 

For: Family Physicians. 1-week course, Sept. 30-0ct. 
4, 1974, Chicago. Hrs. of Instr.: 35 approx. CMiE 

Credit: AMA Category 1. Fee: $200. Sponsor, con- 

tact: Cook County Grad. Sch. of Med., 707 S. Wood 
St., Chicago, IL 60612. 

REVIEW COURSE IN NEPHROLOGY 

For: Family Physicians. 1-week course, Sept. 30-0ct. 
4, 1974, Chicago. Hrs. of InStr.: 35 approx. CME 

Credit: AMA Category 1. Fee: $200. Sponsor, contact: 

Cook County Grad Sch. of Med., 707 S. Wood St.. 
Chicago, IL 60612. 

Neurology 

SPECIALTY REVIEW IN NEUROLOGY- 
PART II, CLINICAL 

For: All Physicians. 1-week course, Sept. 9-13, 1974, 
Chicago. Hrs. of Instr.: 44 approx. CME Credit: AMA 
Category 1. Fee: $200. Sponsor, contact: Cook County 
Grad. Sch. Med., 707 S. Wood St., Chicago 60612. 

Obstetrics /Gynecology 

BASIC GYNECOLOGY 

For: All Physicians. 1 week course, Sept. 16-20, 1974, 
Chicago Hrs. of Instr.: 35 approx. CME Credit: AMA 
Category 1 Fee: $200. Sponsor, contact: Cook County 
Grad. Sch. Med., 707 S. Wood St., Chicago 60612. 

GYNECOLOGICAL LAPAROSCOPY 

For: Specialists, l week course, Sept. 23-27, 1974, 
Chicago. Hrs. of Instr.: 15 approx. CME Credit: AMA 
Category 1. Fee: $250. Sponsor, contact: Cook County 
Grad. Sch. Med., 707 S. Wood St., Chicago 60612. 


56 


Illinois Medical Journal 


Occupational Medicine 

34TH CONGRESS ON OCCUPATIONAL HEALTH 

For: Industrial Physicians, Nurses, & Safety Engineers. 
Symposium-workshop, Sept. 9-10, 1974, Marriott Mo- 
tor Hotel, Chicago. CME Credit: 12 hrs. AMA Cate- 
gory 1. Fee: $20. Sponsor, contact: Henry F. Howe, 
M.D., AMA Dept, of Environmental, Public, & Oc- 
cupational Health, 535 N. Dearborn St., Chicago, IL 
60610. Co-sponsor: Nat’l. Institute for Occupational 
Safety & Health, U.S. Dept, of HEW. 

Ophthalmology 

OPHTHALMOLOGY 

For: All Physicians. 2-day seminar, Sept. 6-7, 1974, 
Wisconsin Center, Madison, Wis. Sponsor, contact: 
Dept, of Cont. Med. Educ., Univ. of Wisconsin Med. 
Sch., 610 Walnut St., Madison, Wl 53706. 

Pediatrics 

COMPREHENSIVE CHILDHOOD 
TRAUMA SYMPOSIUM 

For: All Physicians. 2-day symposium, Sept. 11-12, 
1974, Stouffer's Inn, Indianapolis. Hrs. of Instr.: 14. 
CME Credit: AMA Category 1. Sponsor, contact: Mr 
John Roscoe, Program Co-ord., Indiana Univ. Sch. of 
Med., 1100 W. Michigan St., Indianapolis, IN 46202. 

PROBLEMS IN PEDIATRIC UROLOGY MANAGEMENT 
For: All Physicians. One-day workshop, Sept. 25, 
1974, Indianapolis. Hrs. of Instr.: 7. CME Credit: 
AMA Category 1. Sponsor, contact: Mr John Roscoe, 
Program Co-ord., Indiana Univ. Sch. of Med., 1100 
W. Michigan St., Indianapolis, IN 46202. 

Plastic Surgery 

REVIEW COURSE IN PLASTIC SURGERY 
For: Plastic Surgeons. 3-day lecture series, Sept. 3- 
5, 1974, McGaw Med. Cntr., Northwestern Univ., 
Chicago. Hrs. of Instr.: 18V&. Fee: $200. Reg. Dead- 
line: luly 31, 1974. Sponsor: Dept, of Surgery, 

Northwestern Univ. Med. Sch. Contact: D. A. Ker- 
nahan, M.D., Childrens Memorial Hospital, 2300 Chil- 
drens Plaza, Chicago, IL 60614. 

MANAGEMENT OF INDUSTRIAL INJURIES 
OF THE HAND 

For: Family Physicians, Plastic Surgeons. Symposium, 
Sept. 14, 1974, Barnes Hospital, St. Louis. Sponsor, 
contact: Paul M. Weeks, M.D., Director, Milliken 
Hand Rehab. Cntr., 907 Wohl Clinic, 4960 Audubon 
Ave., St. Louis, MO 63110. Co-sponsor: Washington 
Univ. Sch. of Med. 

Psychiatry 

CURRENT & FUTURE PERSPECTIVES IN 
TREATMENT OF ALCOHOLISM 

For: All Physicians. Lecture, Sept. 13, 1974, 7:30 

PM, Forest Hosp. Professional Cntr., Des Plaines, III. 

Speaker: R J. Catanzaro, M.D., The Palm Beach 
Institute, Florida. Fee: $15 ($5 students). Sponsor, 
contact: Forest Hospital, 555 Wilson Lane, Des 

Plaines, IL 60016; (312) 827-8811, ext. 362. 

Radiology 

GAMMA SCINTILLATION CAMERA WORKSHOP 

For: Specialists. 3-day workshop, Sept. 5-7, 1974. 

Indianapolis. Hrs. of Instr.: 21. CME Credit: AMA 
Category 1. Reg. Limit: 30. Sponsor, contact: Mr. 
John Roscoe, Program Co-ord., Indiana Univ. Sch. of 
Med., 1100 W. Michigan St., Indianapolis, IN 46202. 

Surgery 

MANAGEMENT OF COMPLICATIONS IN SURGERY 

For: All Physicians. 4-day course, Sept. 16-19, 1974, 
Chicago. Hrs. of Instr.: 28 approx. CME Credit: AMA 
Category 1. Fee: $175. Sponsor, contact: Cook County 
Grad. Sch. Med., 707 S. Wood St., Chicago 60612. 

UPPER MIDWEST REVIEW OF GASTROENTEROLOGY 

For: All Physicians.. l l / 2 -day lecture & discussion, 
Sept. 21-22, 1974, Pfister Hotel, Milwaukee. CME 
Credit: 10 hrs. AAFP. Fee: $125. Sponsor, contact: 
The Medical College of Wisconsin, c/o A. T. Fin- 
negan, Course Coord., 561 N. 15th St. , Milwaukee, 
Wl 53233. 

FLUID & ELECTROLYTE MANAGEMENT 

For: All Physicians. 1-week course, Sept. 23-27, 1974. 
Chicago. Hrs. of Inst.: 30 approx. CME Credit: AMA 
Category 1. Fee: $200. Sponsor, contact: Cook County 
Grad. Sch. Med., 707 S Wood St., Chicago 60612. 

BRONCHOSCOPY 

For: Specialists. 1-week course, Sept. 23-27, 1974. 
Chicago. Hrs. of Inst.: 20 approx. CME Credit: AMA 
Category 1. Fee: $200. Sponsor, contact: Cook County 
Grad. Sch. Med., 707 S. Wood St., Chicago 60612. 

DISEASES OF ESOPHAGUS, STOMACH & DUODENUM 
For: All Physicians. 3-day course, Sept 26-28. 1974, 
Chicago. Hrs. of Instr.: 20 approx. CME Credit: AMA 
Category 1. Fee: $125. Sponsor, contact: Cook County 
Grad. Sch. Med., 707 S. Wood St., Chicago 60612. 


SPECIALTY REVIEW IN GEN. SURGERY— PART I 

For: Surgeons. 2-week course, Sept. 30-Oct. 11, 

1974, Chicago. Hrs. of Instr.: 94 approx. CME Credit: 
AMA Category 1. Fee: $350. Sponsor, contact: Cook 
County Grad. Sch. of Med., 707 S. Wood St., Chi- 
cago, IL 60612. 


OCTOBER 


Anesthesiology 

COURSE III— EKG FOR ANESTHESIOLOGISTS 

For: Anesthesiologists. 1-week course, Oct. 28-Nov. 1, 
1974, Chicago. CME Credit: 35 hrs. (approx.) AMA 
Category 1. Fee: $200. Reg. Limit: 35. Sponsor, 
contact: Cook County Grad. Sch. of Med., 707 S. 
Wood St., Chicago, IL 60612. 

Cancer 

20TH FALL CANCER CONFERENCE 
For: All Physicians. Vi-day conference, Oct. 5, 1974, 
University of Wisconsin Hospital, Madison. Fee: $5. 
Sponsor, contact: Dept, of Cont. Med. Educ , Univ. 
of Wisconsin, 610 N. Walnut St., Madison, Wl 53706. 

TUMORS OF URINARY TRACT 

For: All Physicians. Symposium, Oct. 16, 1974, 

Ruth Lake Country Club, Hinsdale, III. CME Credit: 

3 hrs. AMA Category 1. Reg. Deadline: Oct. 14, 
1974. Sponsor, contact: DuPage County Medical Soc., 
646 Roosevelt Rd., Glen Ellyn, IL 60137; (312) 
469-7773. 

Cardiovascular 

BASIC ELECTROCARDIOGRAPHY 

For: Family Physicians. 1-week course, Oct. 28-Nov. 
1, 1974, Chicago. CME Credit: 35 hrs. (approx.) 
AMA Category 1. Fee: $200. Reg. Limit: 35. Sponsor, 
contact: Cook County Grad. Sch. of Med., 707 S. 
Wood St., Chicago, IL 60612. 

Dermatology 

BASIC DERMATOLOGY 

For: Family Physicians. 1-week course, Oct. 14-18, 
1974, Chicago. CME Credit: 30 hrs. (approx.) AMA 
Category 1. Fee: $175. Reg. Limit: 30. Sponsor, 
contact: Cook County Grad. Sch. of Med., 707 S. 
Wood St., Chicago, IL 60612. 

Family Medicine 

FIFTH FAMILY MEDICINE REVIEW 

For: Family Physicians, Osteopaths, Symposium, Oct. 
6-12, 1974, Univ. of Kentucky Medical Cntr., Lexing- 
ton, Ky. CME Credit: 50 hrs. AAFP; 50 hrs. AMA 
Category 1. Fee: $195. Reg. Limit: 250. Sponsor, 
contact: Ofc. of Cont. Educ., College of Med., Univ. 
of Kentucky, Lexington, KY 40506. 

General Interest 

NEWER CONCEPTS OF THE CLINICAL PHARMACIST 

For: All Physicians & Allied Health. Weekly seminar, 

Oct. 1, 1974, 11:30 AM, Memorial Hospital of Du- 

Page Co., Elmhurst, III. CME Credit: 1 hr. AMA 
Category 1. Sponsor, contact: John H. Huss, M.D., 
DME, Memorial Hospital of DuPage Co., Avon Rd. 
& Schiller St., Elmhurst, IL 60126; (312) 833-1400. 

THE OTHER DOCTOR IN YOUR PRIVATE PRACTICE 

For: All Physicians & Allied Health. Weekly seminar, 

Oct. 8, 1974, 11:30 AM, Memorial Hospital of Du- 

Page Co., Elmhurst, III. CME Credit: 1 hr. AMA 
Category 1. Sponsor, contact: lohn H. Huss, M.D., 
DME, Memorial Hospital of DuPage Co., Avon Rd. & 
Schiller St., Elmhurst, IL 60126; (312) 833-1400. 

General Interest /CME Methods 

INTRODUCTION TO CME TECHNIQUE 

For: Hospital and other CME program planners. Two 
identical workshops held simultaneously, Oct. 4-6, 
1974, Marriott Inn, St. Louis and Oak Brook Hyatt 
House, Oak Brook, III. CME Credit: 14 hrs. AMA 
Category 1 (plus 4 hrs. extra on completion of post- 
workshop assignment). Fee: $125. Reg. Limit; Dead- 
line: 20 each; Sept. 20, 1974. Sponsor, contact: 
Illinois Council on Cont. Med. Educ., 360 N. Michi- 
gan Ave., Chicago, IL 60601. 

Geriatrics 

GERIATRICS— IN-DEPTH VIEW 

For: All Physicians. 3-day conference, Oct. 24-26, 
1974, Wisconsin Cntr., Univ. of Wisconsin, Madison. 
Fee: $70. Sponsor, contact: Dept, of Cont. Med. 
Educ., Univ. of Wisconsin, 610 N. Walnut St., 
Madison, Wl 53706. 


Neurology 

3RD ANNUAL CHILD NEUROLOGY SOCIETY MEETING 

For: Pediatric Neurologists. Annual meeting, Oct. 

10-12, 1974, Hilton Hotel, Madison, Wis. Sponsor, 
contact: Child Neurology Society, Box 486 Mayo, 
412 Southeast Union, Minneapolis, Minn. 55455. 

Obstetrics-Gynecology 

SPECIALTY REVIEW IN OB-GYN 

For: Specialists. 2-week course, Oct. 28-Nov. 8, 
1974, Chicago. CME Credit: 86 hrs. (approx.) AMA 
Category 1. Fee: $350. Reg. Limit: 85. Sponsor, 
contact: Cook County Grad. Sch. of Med., 707 S. 
Wood St., Chicago, IL 60612. 

Orthopaedics 

MANAGEMENT OF COMMON FRACTURES 

For: Family Physicians. 1-week course, Oct. 28-Nov. 
1, 1974, Chicago. CME Credit: 30 hrs. (approx.) 
AMA Category 1. Fee: $200. Reg. Limit: 30. Sponsor, 
contact: Cook County Grad. Sch. of Med., 707 S. 
Wood St., Chicago, IL 60612. 

Otolaryngology 

OTOLARYNGOLOGY WORKSHOP 

For: Family Physicians. Seminar, Oct. 30, 1974, 

Indianapolis. CME Credit: 7 hrs. AMA Category 1. 
Sponsor, contact: Mr. John Roscoe, Program Coord., 
Indiana Univ. Sch. of Med., 1100 W. Michigan St., 
Indianapolis, IN 46202. 

Pediatrics 

MANAGEMENT OF PEDIATRIC HEART DISEASE 

For: All Physicians. 3-day course, Oct. 30-Nov. 1, 
1974, Chicago. CME Credit: 21 hrs. (approx.) AMA 
Category 1. Fee: $100. Reg. Limit: 45. Sponsor, 
contact: Cook County Grad. Sch. of Med., 707 S. 
Wood St., Chicago, IL 60612. 

Psychiatry 

PSYCHIATRY FOR THE MEDICAL PRACTITIONER 

For: All Physicians. 4-day course, Oct. 7'-10, 1974, 
Chicago. CME Credit: 24 hrs. (approx.) AMA Cate- 
gory 1. Fee: $175. Reg. Limit: 80. Sponsor, con- 
tact: Cook County Grad. Sch. of Med., 707 S. Wood 
St., Chicago, IL 60612. 

CURRENT & FUTURE PERSPECTIVES IN DRUG ABUSE 

For: All Physicians. Lecture, Oct. 16, 1974, 7:30 
PM, Forest Hospital Professional Cntr., Des Plaines, 
III. Speaker: P. G. Bourne, M.D., Special Action 
Ofc. for Drug Abuse Prevention, Washington, D.C. 
Fee: $15 ($5 students). Sponsor, contact: Forest 
Hospital, 555 Wilson Lane, Des Plaines, IL 60016; 
(312) 827-8811, ext. 362. 

PSYCHOPHARMACOLOGY 

For: Family Physicians, Specialists. Seminar, Oct. 16, 
1974, Indiana Univ. N.W. Campus, Merrillville, Ind. 
CME Credit: 6 hrs. AMA Category 1 Sponsor, con- 
tact: Mr, John Roscoe, Program Coord., Indiana 

Univ. Sch. of Med., 1100 W. Michigan St., India- 
napolis, IN 46202 

PSYCHIATRY FOR THE ADOLESCENT 

For: All Physicians. Lecture, group discussion, Oct. 
23, 1974, 10 AM, Bethany Methodist Hosp.; Oct. 
23, 6 PM, Lincolnwood Hyatt House; Oct. 24, 10 AM, 
Belmont Hosp. Speaker: Beverley Mead, M.D., Dept, 
of Psychiatry, Creighton Univ. Sch. of Med. CME 
Credit: 5 hrs. AMA Category 1. Fee: $10 (non- 
staff, for dinner). Reg. Deadline: Oct. 18, 1974. 
Sponsor: FAB 3 -CME. Contact: Mr. D. Larson, Bethany 
Methodist Hosp., 5025 N. Paulina, Chicago, IL 60640; 
(312) 271-9040. 

Radiology 

DIAGNOSTIC RADIOLOGY 

For: Family Physicians. 1-week course, Oct. 7-11, 
1974, Chicago. CME Credit: 35 hrs. (approx.) AMA 
Category 1. Fee: $200. Reg. Limit: 25. Sponsor, 
contact: Cook County Grad. Sch. of Med., 707 S. 
Wood St., Chicago, IL 60612. 

Surgery 

PRE & POSTOPERATIVE CARE OF PATIENTS 

For: Surgeons, Surgical Specialists. 4-day course, 
Oct. 29-Nov. 1, 1974, Chicago. CME Credit: 32 hrs. 
(approx.) AMA Category 1. Fee: $175. Reg. Limit: 80. 
Sponsor, contact: Cook County Grad. Sch. of Med., 
707 S. Wood St., Chicago, IL 60612. 

Urology 

SPECIALTY REVIEW— UROLOGY 

For: Specialists. 3V2-day course, Oct. 2-5, 1974, 
Chicago. CME Credit: 30 hrs. (approx.) AMA Cate- 
gory 1. Fee: $150. Sponsor, contact: Cook County 
Grad. Sch. Med., 707 S. Wood St., Chicago 60612. 


for July, 1974 


57 


Abstracts of the Board 

( Continued from page 23) 

AMA House those resolutions which favor repeal of PSRO and are consistent with 
the position taken by the ISMS House of Delegates in this matter. 

Support Anesthesiologists 

The Board agreed to support the position of the Illinois Society of Anesthe- 
siologists in the matter of licensing requirements for Ambulatory Surgical 
Treatment Centers. The following was approved: "A licensed physician, or a cer- 
tified registered nurse anesthetist medically directed by a licensed physi- 
cian, who has privileges to administer or direct the administration of anes- 
thesia in a hospital accredited by the Joint Commission on Accreditation of 
Hospitals, shall be present for the administration of anesthetics and recovery 
of patients. The approved program for the facility shall include policies re- 
garding the provision of anesthesia services." 

Council and Committee Appointments 

In the future, county societies will be invited to submit nominations for 
ISMS council and committee appointments. Until now, only off icers and trustees 
have been asked for nominations, with the Board as a whole approving the slate 
of each council and committee. Letters of appointment for 1974-75 committees 
are in the mail. 

Membership Recruitment 

The Board commended the Public Relations Council for its recognition of the 
importance of internal communications with members, but referred back to the 
council its membership recruitment campaign plan. The Board said that some 
parts of the program required further study regarding feasibility. 

Recognition of SIMA 1 OOth Anniversary 

ISMS will present an appropriate plaque to the Southern Illinois Medical As- 
sociation in honor of SIMA's 100th anniversary. 

MEDICHEK 

As a follow-up to Resolution 74M-25, which called for clarification and mod- 
ification of MEDICHEK regulations, the Governmental Health Program Reimburse- 
ment Committee informed the Board it had met with representatives of the Illi- 
nois Departments of Public Health and Public Aid to discuss the four parts of 
the resolution. 

A. Because federal regulations mandate the implementation of MEDICHEK 
throughout the country, the Board recognized the impracticality of requiring 
its annual approval by county medical societies. 

B. The committee reported that the federal MEDICHEK program could not be 
under the "direct control of the peer review and ethical relations committees 
of the local county medical society," as specified in the resolution but that 
state officials welcomed review and comment from these sources. The Board in- 
structed the committee to seek a stronger commitment from state officials and 
continue its dialogue with them in this area. 

C. The committee's recommendation that physicians be encouraged to charge 
usual and customary fees for services under MEDICHEK was approved by the Board , 
and the committee was instructed to obtain a firm commitment from the Department 
of Public Aid that the present maximum fee schedule would be reviewed and ad- 
justed accordingly at the end of six months. 

D. It was reported that the pilot projects referred to in the resolution were 
already operating and no further action needed. 

In a related action, the Board commended Joel Edelman, Director of the Depart- 
ment of Public Aid, for his efforts to keep confidential the record of IDPA pay- 
ments to individual physicians preventing such data from being sensational- 
ized in the public press. 


58 


Illinois Medical Journal 


Problems of Pharmaceutical Industry 

The Board directed the Executive Committee to assign to an appropriate ISMS 
committee the problem of bureaucratic intervention in the pharmaceutical in- 
dustry and to study generic vs. brand name prescribing with a view toward de- 
veloping a position for ISMS to take in this matter. 

Peer Review Appeals 

A question involving the right of insurance carriers to utilize the ISMS peer 
review process was resolved by referring to the following bylaws statement: 
"Any party to the proceedings considering himself aggrieved by the findings 
and recommendations of the (local) committee shall have the right to appeal 
through the component society to the Illinois State -Medical Society." 


Psychotherapy Definition 

In keeping with House Action, the Board approved and referred to the Policy 
Committee the following definition: 

Medical Psychotherapy is a medical procedure for the treatment of mental 
and physical ailments or illness. It involves verbal or non-verbal communi- 
cations with the patient, and always includes continuing medical diagnostic 
evaluation and drug management as indicated. Medical psychotherapy may be 
performed only by a physician licensed to practice medicine in all of its 
branches, who has had training in psychiatric medicine. 

Mental Health Department Budget 

At the request of the Council on Mental Health and Addiction, the Board di- 
rected the Governmental Affairs Council to take appropriate action toward in- 
creasing the Illinois Department of Mental Health budget so that $5 million 
would be available for the purchase of care for mental treatment in licensed 
private psychiatric facilities. 

Proposed Mental Health Department Rules 

ISMS will object to the Mental Health Department's proposed Rule 12.09, which 
outlines the procedure to be followed for administering psychotropic drugs in 
state facilities. The department will be asked to delay implementation until 
the council has had an opportunity to review and comment on proposed rules. 

Revision of Mental Health Code 

Noting the need for physician guidance in the proposed revision of the Illi- 
nois Mental Health Code, the Board will urge ISMS members to send their sugges- 
tions for code changes to the state medical society for forwarding to the Revi- 
sion Committee. 

Other Legislation 

On recommendation of the Medical Legal Council, the Board rescinded its pre- 
vious endorsement of HB 751, the Clinical Research Act, because of amendments 
and changes being contemplated by the legislature. ISMS will now oppose the 
bill in its present form and referred the matter back to the Medical Legal Coun- 
cil to develop appropriate amendments. 

The Board also referred to the Governmental Affairs Council a recommendation 
that ISMS support HB 2571, which would amend the Controlled Substances Acts, 
and HB 2826, which would create a Dangerous Drug Commission. 

The Board also: 

Will not endorse HB 2225, the Comprehensive Health Service Act unless ap- 
propriately amended ; 

Not support proposed legislation rescinding exemption, for religious beliefs, 
from mandatory immunizations and other mandatory medical procedures ; 

Oppose HB 2217, which would create a new class of crimes related to controlled 
substances ; 

Referred to the Executive Committee a recommendation to oppose HB 2710, which 


for July, 1974 


59 


would require legislative approval for the closing or reducing of programs in 
state mental hospitals. 

Oppose HB 1412, Nursing Practice Act amendment, until the Joint Practice Com- 
mittee has taken a position on it: 

Support HB 2757, the Health Professional Student Loan Program, if ISMS amend- 
ments are accepted by the sponsor; 

Vigorously oppose SB 1500, which would grant permanent limited licenses to 
hospital permit physicians under certain conditions. 

Plan for Perinafal Health 

On recommendation of the Council on Environmental and Community Health, the 
Board endorsed the final version of a Plan for Perinatal Health in Illinois. 
The council stated that implementation of the plan will result in improved care 
for both the high-risk mother and high-risk infant. 

Proposed Rules for Sodium, Nitrate and Nitrite Content in Drinking Water Supplies 

The Board endorsed the Illinois Environmental Protection Agency's proposed 
rules for sodium, nitrate and nitrite content in drinking water supplies. The 
new standards update present Illinois standards and bring them into line with 
federal guidelines. 

Health Care Delivery Problems in Spanish-Speaking Communities 

The Board approved a recommendation of the Council on Social and Medical Ser- 
vices that ISMS, in collaboration with local medical societies, explore the pos- 
sibility of sponsoring conferences for health care providers and agencies lo- 
cated in predominantly Spanish-speaking neighborhoods. 

Guidelines for Weight Reduction Programs 

As a follow-up to approving a position statement on the use of human chorionic 
gonadotropin in weight reduction, the Board endorsed a set of "Guidelines in 
the Selection of a Weight Reduction Program." The guidelines are to be submitted 
to the Illinois Osteopathic Association for its consideration and possible co- 
sponsorship, since there are osteopaths being employed by weight clinics. 

The Board also agreed that the guidelines be given wide public distribution via 
the mass media, that they be reproduced on appropriate-sized cards for distri- 
bution to patients in physicians' offices and other health facilities, that 
they be made available to the AMA Council on Foods and Nutrition, and that the 
ISMS work with the Illinois Department of Public Health in exploring the need 
for regulating weight control businesses in Illinois. (Guidelines appear on 
page 19. ) 

Professional Liability in Patient Care 

The Medical Legal Council was authorized to begin development of a revised 
version of the "Physician's Liability in Patient Care" booklet, with produc- 
tion costs allocated from the council ' s budget. Legal counsel will review ma- 
terials before they are published. 

Special Advisory Committee to IDPH 

A proposal to develop a special Legislative Advisory Committee to Illinois 
Public Health Director Joyce Lashof has been referred to the Executive Com- 
mittee, which will consult with the Illinois Hospital Association and others 
interested in establishing this committee. The Governmental Affairs Council 
recommended to the Board that existing ISMS councils and committees be utilized 
rather than another advisory committee. 

Legislative Seminar 

The Public Affairs Committee will sponsor a Legislative Seminar September 20- 
22 at Chateau Louise in Dundee. Invitations will be mailed to 3,500 physicians 
and spouses on the mailing list for On the Legislative S cene. Information group 
discussions on the legislative process are planned, with legislators serving as 
faculty and physicians as students. ■< 


60 


Illinois Medical Journal 


Swimming Instructions for 
Pre-School Children 

(Continued from page 27) 

Pediatricians do not claim to be experts on 
swimming or swimming instruction, but they 
will justifiably claim to be experts on child 
development. They also will claim a better 
perspective, a broader view of the child in the 
longitudinal consequences of various pressures 
and influences on his emotional integrity. We 
are a success oriented society with ever-decreasing 
ability to delay the gratification of success. The 
child’s best interests must always be paramount 
in all programs aimed at making him perform 
or excel. ^ 


Patronize 


Your 


Advertisers 


Swimming Safety 

As the outdoor swimming season approaches, the safety 
experts predict with certainty that some thousands of 
Americans will drown in the coming summer months. 

They will drown in swimming pools, in lakes and 
streams, at ocean beaches. Some will drown while in for 
a refreshing dip and others will fall out of boats and off 
docks and piers. 

Many, if not most, of these drownings need not happen. 

The American Medical Association offers some basic 
safety rules that can help to avoid a tragic water accidents. 

• Learn to swim and to relax in the water. 

• Never swim alone. 

• Do not swim when overly tired or when the water 
is extremely cold. 

• Do not overestimate your ability and endurance. 

• Swim at protected pools or beaches under the 
supervision of a trained lifeguard. 

• If a boat overturns, stay with it and don’t try to 
swim a long distance to shore. 

• Never dive into water of unknown depth. 

• Try new activities, such as water skiing or scuba 
diving, only after learning the skills from qualified 
instructors. 

Many families will do most of their swimming this 
season in private pools, in their own backyards or in those 
of a friend or neighbor. There also are some special safety 
precautions for private pools. 

• Make certain the pool is kept clean and the water 
chemically purified. 

• Walk, don’t run, about the pool. Horseplay is 
dangerous. 

• Fence the pool and keep the gate locked to keep 
out small children. 

• Keep handy rescue equipment, such as long poles 
and ring bouys. 

• Keep bottles and glasses away from the concrete or 
metal pool deck. 


EKG of the Month 

( Continued from page 45) 

Answers: 7. D. 2. E. The rhythm strip shows SA 
block with short pauses. These should not be con- 
tused with non-conducted premature atrial beats 
followed by an incomplete compensatory pause. 
No premature p waves can be seen. During 
monitoring long pauses were documented that 
probably produced the syncope. Other mecha- 
nism in patient on thioridazine and chlorproma- 
zine is ventricular tachycardia and fibrillation. 
This was not seen. Serum lithium level was 2.5 
mEq/L (therapeutic range 0.5 to 1.5 mEq/L) . 
Patient refused pacemaker. Isoproterenol was 
started. 

Patient improved and SA block disappeared 
with decreasing lithium levels only to reappear 
when drug was restarted. Most frequent causes 
of SA block include drug toxicity (digitalis, 
quanidine, and potassium salts) , acute myocar- 
ditis, and myocardial ischemia. Since our patient 
had no other cause for the black, but had high 
lithium levels, the possibility of lithium induced 
SA block is raised. ■< 


COOK COUNTY 
Graduate School of Medicine 

CONTINUING EDUCATION COURSES 
STARTING DATES, 1974 

SPECIALTY REVIEW FOR FAMILY PRACTICE, August 12 
SPECIALTY REVIEW IN ORTHOPAEDICS, August 25 
SPECIALTY REVIEW COURSES IN PULMONARY & RHEUMATOLOGY, 
September 9 

SPECIALTY REVIEW COURSES IN HEMATOLOGY. INFECTIOUS 
DISEASES & NEPHROLOGY, Sept. 30 
SPECIALTY REVIEW IN SURGERY, PART I, Sept. 30 
SPECIALTY REVIEW IN OBSTETRICS & GYNECOLOGY, Oct. 28 
SPECIALTY REVIEW IN MEDICINE, RECERTIFYING, Oct. 14 
SPECIAL COURSE IN GYNECOLOGIC PATHOLOGY, Oct. 14 
MANAGEMENT OF COMPLICATIONS IN SURGERY, 4 Days, Sept. 16 
MANAGEMENT OF COMMON FRACTURES, One Week, Oct. 28 
FLUIDS & ELECTROLYTES, One Week. Sept. 23 
BASIC GYNECOLOGY, One Week, September 16 
BASIC ELECTROCARDIOGRAPHY, One Week, Oct. 28 
INTERMEDIATE CARDIOLOGY, September 23 
NEUROLOGY, PART II, CLINICAL, One Week, September 9 
PSYCHIATRY FOR THE MEDICAL PRACTITIONER. 4 Days, Oct. 7 
STATE & NATIONAL BOARD REVIEW, Basic & Clinical, 

Oct. 14 & 20 

Information concerning numerous other continuation 
courses available upon request. 

Address: 

REGISTRAR. 707 South Wood Street, 
Chicago, Illinois 60612 


for July, 1974 


61 


The Cholesterol Hypothesis and 
the Coronary Primary Prevention 

( Continued from page 30) 

7. Leren, P.: "The Effect of Plasma Cholesterol Lower- 
ing Diet in Male Survivors of Myocardial Infarction.” 
Acta Med. Scand. Suppl. 466:48-92, 1966. 

8. Leren, P.: “The Oslo Diet-Heart Study. Eleven-Year 
Report.” Circulation 40:935-942, 1970. 

9. ‘‘Report of a Research Committee to the Medical Re- 
search Council: Controlled Trial of Soya-Bean Oil in 
Myocardial Infarction,” Lancet, 11:693-699, 1968. 

10. Olson, R. E.: Prevention and Control of Chronic Dis- 
ease: 1. “Cardiovascular Disease— With Particular 

Attention to Atherosclerosis.” Amer. J. Pub. Health 
49:1120-1128, 1959. 

11. Protocol for the Lipid Research Clinics Type II Coro- 
nary Primary Prevention Trial. April, 1973. 


EDITORIAL : Angina Pectoris 

(Continued from page 53) 


such drugs as guanethedine, alpha-methyldopa, 
and propranolol. The spasms may respond to 
nitroglycerin. 

Spasm appears to be the logical cause but not 
all cardiologists consider this a satisfactory ex- 
planation. In addition, there is no standard 
remedy, except when medical therapy is not ef- 
fective, a surgical approach should be attempted. 
Various methods have been tried. Those with no 
significant coronary disease as shown on the 
angiograph do well on nitroglycerin and sub- 
lingual isosorbide. 

T. R. Van Dellen, M.D. 

Editor 


References 

1. “Prinzmetal Variant of Angina Pectoris.’, Editorials, 
JAMA 228:3 (April 15) 1974. 

2. “Prinzmetal Variant Angina Covers a Wide Spectrum.” 
Internal Medicine Neivs (April 1) 1974. 


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Phone:312-679-1000 



ISMS MEMBERSHIP PRIVILEGE 


Central Illinois Service Office: 849 Forest Lane — Petersburg, III. 62675 • phone 217-632-7220 

Wayne J. Hubbert, District Manager 


62 


Illinois Medical Journal 



Physician Recruitment Program 


In an effort to reduce the number of towns in Illinois needing physicians, the Physician Recruitment Program and the Doctor’s 
Job Fair, are publishing synopses in the Journal. 

Physicians who are seeking a place to practice or who know of any out-of-state physicians seeking an Illinois residence are 

asked to notify the Program. 

Any areas wishing to be listed should contact: Mrs. E. Duffy, Physician Recruitment Program, ISMS, 360 North Michigan 
Ave., Chicago, 60601. 


ALEDO: Mercer County, 17,000 population, needs addi- 
tional family physicians. 4 active physicians at present. 
General acute hospital in Aledo. High quality medical 
care economically rewarding. Thirty miles from met- 
ropolitan quad-city area. Good small community for 
family living. Contact: Shirley Lindberg or Monty 
McClellan, M.D., 308 NW Fourth Street, Aledo, 61231, 
309/582-5156. (10) 

BLOOMINGTON: General Practitioners, Internists, 
Pediatricians and a Surgeon needed to help establish 
a multi-specialty clinic in a new Erdman Building. 
Corporate practice with all the usual benefits. Contact: 
Paul G. Theobald, M.D., #1 Medical Hills Dr., Bloom- 
ington, 61701, 309/828-6051. (10) 

CHAMPAIGN: Private hospital expanding and build- 
ing new 110 bed facility. We are seeking a General 
Surgeon, Internist and Family Practitioner. Minimum 
guarantee offered. Contact: Donald L. Francis, Ex- 
ecutive Director, Cole Hospital, Inc., 809 W. Church 
Street, Champaign, 61820; (217) 356-3788. (8) 

CHARLESTON: Small midwestern University Health 
Service serving 8,000 students, 4% day week; no after 
hours or weekends. Perfect for post-retirement. Five 
weeks vacation and one week for medical meetings. 
Life insurance, health insurance, and University Re- 
tirement System. Contact: Director, Health Service, 
Eastern Illinois University, Charleston, 61920, (217) 
581-3013. (10) 

CHENOA: Rural area, 100 miles south of Chicago on 
1-55. Looking for one or two physicians to do family 
practice. Hospital facilities nearby. Financial assistance 
and office space can be arranged. Contact: R. J. Walk- 
er, National Bank of Chenoa, Chenoa, 61726, 815-945- 
2311. (10) 

CHICAGO: Private young multispecialty group seeks 
General Practitioners or Medical Specialist. University 
affiliation available. Spanish speaking M.D. welcomed. 
Contact: Dr. Finley W. Brown or Dr. Gonzalo Ruiz, 
3109 W. Armitage, Chicago, 60647, 312-276-8811. (7) 

CHICAGO: Generalist or Internist wanted for full- 
time practice in welfare neighborhood. New office, 
unlimited financial opportunity. For details contact: 
Mrs. Grescio, Dr. G. Mizock Office, 6201 N. California, 
Chicago 60645. 312-642-1094 (8) 

CHICAGO & SUBURBS: Privately owned multi- 
specialty clinic, 40-48 hour week. Day and/or night 
work. Contact: Joseph Lentini, Garfield Medical Cen- 
ter. (312) 624-4200 or (312) 427-3343. (8) 


CHICAGO: Board Certified or eligible, Internal Medi- 
cine, Illinois Registration. Medical Center, providing 
preventive and therapeutic medical care with other 
specialists and diagnostic services on premises. Ad- 
ministrative Ability an Asset, Salary Open, Commen- 
surate with background and experience. Call Collect: 
William A. Hutchison, M.D., Union Medical Center, 
1657 West Adams, Chicago, 60612, (312) 829-1134. (10) 

CREVE COEUR: M.D. URGENTLY NEEDED as an 

associate in a very active practice in the Peoria area, 
hospitals. Present M.D. wishes to retire soon and is 
Family or General Practice within six miles of three 
hospitals. Present MD. wishes to retire soon and is 
concerned with his patients. Financial arrangements 
and over-all needs negotiable. Only those seriously 
interested in private practice call collect 309-699-8022 
or 309-699-5525 or write William Long, M.D., Creve 
Coeur, 111, 60601. (2) 

DEKALB: Northern Illinois University Health Service 
needs Internist; General Practitioner; and Gynecol- 
ogist or practitioner with wide experience in gyne- 
cology and family planning. Reduced paper work, 
better hours, inquiring patients, new health care de- 
livery systems, and University atmosphere provide 
interest. Illinois license required. Equal Opportunity 
Employer. Write L. W. Akers, M.D., Director. NIU 
Health Service, DeKalb 60115. (10) 

FLORA: Population 6,000, Patient- drawing area larger. 
G. P., Internist, Pediatrician. Group or solo. Office 
space can be arranged to suit your needs. Unusually 
well-equipped small hospital with excellent lab and 
X-ray facilities and ICU. Nearby specialty consultants. 
Fine school system and availability of homes. For 
information contact: Administrator, Clay County Hos- 
pital, Flora, 62839, 618-662-2131. (10) 

GENESEO: Family Practice; Ped., Ob-Gyn, Int. Medi- 
cine who will also do General Practice. Population 
7,000 serving area 30,000 on Interstate 80, 2% hrs. 
from Chicago, 25 miles from Quad-Cities metropolitan 
areas, over 300,000. Safe, ideal, small city living, 110 
bed ultra-modern hospital, excellent schools, recrea- 
tional facilities. Hospital has just completed construc- 
tion of two new modern doctor’s offices on hospital 
property which are available immediately. Guarantee 
monthly gross income. Clement G. McNamara, 210 W. 
Elk St., Geneseo, 61254. Call collect (309) 944-6431. (10) 

HARVARD: Population 5,200, estimated trading area 
20,000. Three physicians at present, previously five. 
Center of rapidly growing and financially sound area. 


for July, 1914 


63 


65 miles northwest of Chicago, 30 miles east of Rock- 
ford. Contact: J. M. Holcomb, Harvard Com. Hosp.. 
Grant & McKinley Sts., Harvard, 60033. (10) 

JERSEYVILLE: population 8000. Trade area: 19,000. 
County medical society very anxious for additional 
physicians to locate here. 9 practicing physicians at 
present. Jersey Community Hospital located here; 
54 beds. 20 miles from Alton. Office space available. 
Financial assistance available. German-Irish com- 
munity. 14 protestant & catholic churches. Grade & 
high schools including parochial. 20 miles from South- 
ern 111. U., Country Club with golf course. 1 hour to 
St. Louis. Contact: William B. Watts, Administrator — 
508 W. Pine St., Jerseyville, 62052. Phone: (618) 

498-2133. (8) 

LEXINGTON: Population 1700. Just 15 minutes away 
from Bloomington. Office facilities available. Great 
need for a doctor in the community. Lucrative prac- 
tice waiting. All recreational facilities nearby. Con- 
tact: Michael Payne, Association of Commerce and 
Industry of McLean County, 210 South East Street, 
Bloomington, 61701, (309) 829-6344. (8) 

LIBERTYVILLE — Thirty-Five miles northwest of Chi- 
cago. Population 12,000 — serving 40,000. Group practice 
of Family Physicians. Affiliated with a 175 bed hospi- 
tal. Corporation benefits. Salary guarantee. Beautiful 
country for lake sports. Contact: Dr. Mark Fields, 716 
S. Milwaukee Rd„ Libertyville 60048, 312-362-1390. (10) 

METROPOLIS: Physicians wanted. Complete office 
facilities. Financial assistance available. Modern, well 
equipped hospital serving tri-county area in scenic 
southern Illinois. Contact: Charles Russell, Adminis- 
trator, Massac Memorial Hospital, Metropolis, 62960, 
(618) 524-2176. (10) 

MONMOUTH: Services area population 30,000. Open- 
ing for Family Practice and OB-GYN. Modern well- 
equipped hospital — 141 beds. Near Highways 1-74 & 
1-80. Daily rail to Chicago. Flight service available. 
Safe place to raise family. Near medical school, liberal 
arts college. Contact: Roger E. Gurholt, 1000 W. 
Harlem Ave.. Monmouth, 61462. 309-734-3141. (10) 

PAXTON: Population 5400. Service area population 
20,000. Two hours from Chicago; thirty minutes from 
Champaign-Urbana. This area needs another MD to 
share two physician clinic with a general surgeon. 
Free rent, office help offered. Contact: Dr. M. Y. Que, 
or Harry Dubets, Administrator, Paxton Community- 
Hospital, 651 E. Pells St., Paxton 60957, 217-379-2387. 
( 8 ) 

PEMBROKE TOWNSHIP: Population 6,000. Opening 
in new medical facility. Seventeen miles east of 
Kankakee and 60 miles south of Chicago. Financial 
assistance available. Contact: Andrew J. Hargrett, 
135 West Court Street, Kankakee 60901. AC 815-939- 
7304. (8) 

PITTSFIELD: Need family practitioners and sur- 
geons interested in locating in rural community area. 
Population 4100; area 18,000. Excellent opportunity 


for someone wanting to practice in a rural community. 
Located between Jacksonville and Quincy, on High- 
way 54 and 36. Contact Dr. T. C. Bunting, Illini 
Community Hospital, Pittsfield 62363. AC 217-285-2141 
or 217-285-2113. (12) 

QUINCY: OBG, Ind. Med., Fam. Prac., Ortho., Derm., 
GU to join 18-man clinic. Large modern clinic, many 
benefits, two well-equipped hospitals. Excellent schools, 
cultural, recreational advantages. Good family city. 
Above average earnings. Write or call collect: Mr. 
Judson C. Green, Quincy Clinic, 1400 Maine St., 
Quincy, 217-222-6550. (8) 

RANSOM: General Practice — free rent and use of 
modern equipment and brick building for one year. 
Brick building consists of doctors’s, nurses, recep- 
tionist’s offices, large reception room, laboratory and 
office and (2) treatment rooms. 80 miles southwest 
of Chicago, RTE 170, St. Mary’s Hospital Staff, 
Streator Practices Reaches A 25 mile radius. Contact 
Mrs. Delmar Jones; Phone 815-586-4229. (8) 

ROCHELLE: Population 10,000. General Practitioners, 
Internist-Cardiologist. Group or solo practice. Located 
75 miles West of Chicago, near new medical school 
and university. $2,000,000 addition, 1971. Ultra-mod- 
ern, 70-bed hospital; new offices adjacent. Excellent 
schools, recreation. Visit at our expense. Contact: 
Robert Knapp, Rochelle Community Hospital, Rochelle 
61068, 815-562-2181. (8) 

SAVANNA: Pediatrician, Internist, or General Prac- 
titioner. Illinois community of 5,000 population on 
Mississippi River. 40-bed open staff hospital; excep- 
tional recreational facilities; excellent schools and 
churches of all denominations. Option to practice 
alone or in partnership. Contact: William J. Dayton, 
202 Mead.owview Knoll, Savanna, 61074, 815-273-2755. 
( 10 ) 

SHELBYVILLE : Population 6,000 — drawing population 
22,000. New eight man medical ctr. recently opened 
and attached to 100 bed hospital. Object to secure a 
medical practice group. Central location within com- 
muting distane of Springfield — 60 miles, Decatur 35 
miles & St. Louis 115 miles. Located on large lake rec- 
reational area. Contact: John Snyder, Shelby County 
Memorial Hospital, 1st & Cedar Sts., Shelbyville, 62565, 
217-774-3961. (10) 

STREATOR: Internist, Family Physician, Pediatrician, 
Surgeon, and Orthopedic Surgeon needed to join 11 
physician multispecialty group in community of 
20,000 with new clinic across from new hospital, 
excellent practicing facilities for energetic physicians, 
full insurane benefits, guaranteed income; teaching 
opportunities. Contact: C. T. Hawkins, M.D., Streator 
Medical Clinic, S.C., 104 Sixth St., Streator, 61364, 
815-672-0511. (8) 

WHEATON: Pediatrician (s) to join unique medical 
office condominum. College town 25 miles west of Chi- 
cago. Practice arrangements flexible. Rapid practice 
expansion assured for right individual (s). Contact: 
Douglas B. Mains, M.D., Mona Kea Professional Park, 
393 Schmale Road, Wheaton, 312-665-9777. (7) 


64 


Illinois Medical Journal 


Obituaries 


““Berg, Edward Paul, Chicago, died May 5, at the age 
of 82. He had been a general practitioner, surgeon; he 
was a graduate of the Chicago Medical School in 1916. 
Dr. Berg also had practiced medicine for more than 50 
years. 

“Baumann, Milton C., Springfield, died March 21 at the 
age of 63. He graduated from the University of Illinois 
in 1937. He was affiliated with the Department of Psy- 
chiatry and Neurology at the Baumann Clinic. 

“Coombs, Robert, Chicago, died May 29 at the age of 
73. He graduated from Rush Medical School in 1925. Dr. 
Coombs was a former instructor in surgery at the Re- 
search Educational Hospital and a lecturer in surgery at 
the Grant Hospital Training School for Nurses. He also 
was a member of the attending staff at Grant Hospital 
for 47 years. Dr. Coombs was the grandson of Dr. Jacob 
Frank, world famous Chicago surgeon of the early 1900’s. 

“Davidson, Woodram W., Centralia, died June 4, at the 
age of 62. He graduated from the University of Illinois 
in 1948. 

“Eshbaugh, Dorothy E., Chicago, died June 1, at the 
age of 56. She graduated from the Womens Medical 
School of Pennsylvania in 1942. Dr. Eshbaugh was as- 
sistant director of pathology at Michael Reese Medical 
Center and a professor and consultant on the staff of 
Chicago Medical College. Previous to serving at Michael 
Reese Hospital, she had served on the pathology staff at 
Rush-Presbyterian-St. Lukes Medical Center. 

“Garcia, F. D., Florida, died April 29, at the age of 80, 
He graduate from the Chicago Medical School in 1923. 

““Gorov, Ida Ruth, Chicago, died December 30, at the 
age of 80. She graduated from the Chicago Medical 
School in 1917. Dr. Gorov also has practiced medicine 
for more than 50 years. 

“Gough, J. A., Florida, died May 14, at the age of 79. 
He graduated from Rush Medical College in 1922. Dr. 
Gough was an Obstetrician and Gynecologist for more 
than 35 years. He was to have been honored May 15 by 
the Presbyterian-St. Lukes Hospital on the 50th anni- 
versary of his enrollment on its staff, where he became 
an emertius member of the staff 16 years ago. 

“Gurvey, Julius A., Chicago, died May 9, at the age of 
69. He was Medical Director for the Wilson Sporting 
Goods Co. and Steel Supply Division of the United 
States Steel Corp. Dr. Gurvey also was a staff member 
of St. Elizabeth’s Hospital. He was a 1929 graduate of 
the University of Illinois. 


“Hickerson, R. G. Sr., Galesburg, died June 5, at the age 
of 66. He graduated from the LTniversity of Illinois in 
1933. 

“Jones, Alexander J., Springfield, died April 3, at the age 
of 73. He graduated from the LTniversity of Edinburgh, 
Scotland in 1928. 

“Lodato, Victor, Chicago Heights, died May 24, at the 
age of 62. He graduated from the Chicago Medical 
School in 1941. Dr. Lodato was an associate of the 
Boulevard Medical S.C., in Chicago Heights. He was also 
a staff member of St. James Hospital for more than 30 
years and also a past president of the hospital. 

““Matthies, Mabel, Arizona, died March 26, at the age 
of 91. She graduated from the Dearborn Medical School 
in 1907. Dr. Matthies practiced medicine for more than 
50 years. 

“O’Malley Sr., Francis X., Chicago, died June 2, at the 
age of 77. He had been a physician and a staff member 
of St. Joseph’s Hospital. 

“Rudder, Ralph C., Arizona, died May 15, at the age of 
69. He graduated from the Chicago Medical School in 
1945. 

“Sass, Louis A., Oaklawn, died May 22, at the age of 60. 
He graduated from Rush Medical School in 1939. Dr. 
Sass was a past president of the staff at Evangelical 
Hospital. He was also past president of Christ Com- 
munity and associate professor of medicine at Rush 
Medical School. 

““Van Alyea, O. E., Winnetka, died May 5, at the age 
of 87. He had been a well known otolaryngologist, best 
known for his international text books on nasal sinuses. 
Dr. Van Alyea joined the faculty of the LTniversity of 
Illinois College of Medicine as an assistant in otolaryn- 
gology in 1929 and became Clinical Professor of oto- 
loryngology in 1941. When he retired in 1957, he was 
honored with emeritus status. He continued his interest 
in education and research. 

“Watt, Lucille, Chicago, died June 3, at the age of 78. 
She received her Medical degree from Rush Medical 
College in 1943. Dr. Watt served on the staff of Billings, 
Presbyterian and Passavant Hospitals, where she was di- 
rector of anesthesia from 1959 until she retired in 1964. 

“Wittier, Marie H., Arkansas, a former resident of Elm- 
hurst, died March 25 at the age of 64. She graduated 
from the Washington University School of Medicine, St. 
Louis, Mo., in 1937. 

° Denotes member of ISMS 
00 Denotes member of 50-Year Club of ISMS 


for July, 1974 


65 


CLASSIFIED ADVERTISING 


Positions & Practice Opportunities 


IMMEDIATE FAMILY PRACTICE OPENING-in two man clinic. Liberty- 
ville, Illinois, 35 miles northwest of Chicago. Initial salary and early 
partnership. Busy practice in small suburban town. Call collect— 
Dr. Lawrence C. Day (312) 362-1447. 


WANTED: OB-GYN, SURGEON and INTERNIST for nine man group. 
Thirty miles southwest of Chicago, excellent hospital, housing and 
schools. $30,000 guarantee first year. Write to Box Number 782, 
c/o Illinois Medical Journal, 360 N. Michigan Ave., Chicago, 
Illinois 60601. 


ATTENTION PHYSICIANS! CHICAGO MEDICAL CENTERS-Welfare 
area in need of physicians. Please contact: Mr. Robert Fields (312) 
236-2555. 


GENERAL INTERNISTS and GENERALISTS: For growing sub-sections 
of 45 man medical department, including allergists, psychiatrists, 
neurologists, all sub-specialties and expanding primary care section. 
Multispecialty group of 120. Large patient population and area re- 
ferral. Functioning HMO. Generous salary and fringe benefits. Peace- 
ful setting near Wisconsin vacationland and cities. Good schools, 
cultural advantages. Junior College. Educational and research pro- 
grams. Liberal schedules, little practice pressure. New Clinic and 
hospital developing. Write or call J. L. Struthers, M.D., Marshfield 
Clinic, Marshfield, Wisconsin 54449. 


FAMILY PRACTITIONERS— Expanding 880 bed multiple facility medi- 
cal center in Chicago is seeking family practitioners (individual or 
groups) to join the staff of its family practice oriented facility— 230 
bed hospital located on the near West Side. The hospital will provide 
an office and furnish equipment to establish private practice at a 
mutually agreeable site in the nearby community— no investment by 
physicians required— and guarantee annual private practice income to 
a $36,000 minimum for one to five years (negotiable). Send Curric- 
ulum Vitae to Box 825, c/o Illinois Medical Journal, 360 N. Michigan 
Avenue, Chicago, Illinois 60601. 


OZAUKEE COUNTY NEEDS Family Practitioners, Orthopedist, and 
Pediatricians to provide health care for over 55,000 affluent people. 
St. Alphonsus Hospital, located in the center of Ozaukee County, is 
an orderly, modern facility ready to provide acute hospital care. 
Office space is available here and in nearby cities and villages. 
Contact George A. Seidenstricker at St. Alphonsus Hospital, 743 
North Montgomery Street, Port Washington, Wisconsin 53074. Phone 
414-284-5511. 

P.S. Spend the day with us so we can show you and your family 
everything . . . schools, shops, homes, parks. 


Immediate opening for Ob-Gyn, Internal Medicine, and Orthopedic 
specialties to establish successful practice with 14-man multi-specialty 
group. Excellent group benefits; pension plan; modern clinic facili- 
ties; progressive community with excellent educational system includ- 
ing two colleges; city population 35,000; good recreational facilities; 
each specialty must be board eligible or certified. Contact: Business 
Manager, The Manitowoc Clinic, 601 Reed Avenue, Manitowoc, Wis- 
consin 54220. 


A BETTER PLACE TO PRACTICE MEDICINE: Enioy practicing medicine 
in a warm climate, and with the friendly people in Wichita Falls, 
Texas. Our brand new 55,000 square foot clinic building has new 
offices and examining rooms ready for specialists in Internal Medi- 
cine, Family Practice, and Diagnostic Radiology. We are a multi- 
specialty group located in a city of 100,000 people in North Central 
Texas— close to everything— but away from big city problems. Call 
collect Dr. Preston McCall at (817) 766-3551, at 501 Midwestar 
Parkway, East, Wichita Falls, Texas 76302. 


ANESTHESIOLOGIST— Immediate opening with fully-accredited mod- 
ern trauma center hospital in progressive and growing community. 
Excellent guarantee. Contact Administration, St. Joseph's Hospital, 
Bloomington, Illinois 61701, (309) 662-3311. 


Positions & Practice Opportunities (Con’t) 


PRACTICE and OFFICE AVAILABLE, about August 1, 1974, in a 
growing central Illinois town. Size 10,000, local hospital 75 beds, 
and 6 area nursing homes. Principally GP, OB, Geriatrics & in- 
dustrial practice. Price Negotiable. Present location 35 years. In- 
come 50,000-75,000. Reason for moving, health and age. Write: 
Box 831, c/o Illinois Medical Journal, 360 N. Michigan Ave., 
Chicago, IL 60601. 


FAMILY PHYSICIANS OR GENERAL INTERNISTS - NEW MEDICAL 
CENTER, COUNTRYSIDE-LAGRANGE: Area fujl or part time excellent 
arrangement regarding benefits 100,000 insurance (life), malpractice. 
Car credit card + practice pre-paid. Also H.M.O. Some Fee for 
service. Hal Halihan, Co-Administrator, Countryside Health Care 
Center, Inc. 6160 W. Joliet Rd., Countryside, Illinois 60525. 


Well-established, prosperous North-Michigan Avenue, Chicago In- 
ternist practice available because of sudden death. Sub-specialties 
in Electrical Cardiography and Allergy. Especially able and loyal 
staff and equipment also available. Financial information and further 
detail furnished promptly to interested parties. Contact Richard W. 
Burke, Attorney, 3220 Prudential Plaza, Chicago, Illinois 60601, (312) 
944-2400. 


MEDICAL DIRECTOR for permanent, fulltime position with a neigh- 
borhood health center at the University of Illinois Hospital and Medi- 
cal School. Academic appointment, excellent salary and fringe bene- 
fits. Opportunity for innovative medical care research in systems and 
manpower. Student and community education programs. Work with 
inner city population adjacent to the Medical Center complex. ILLI- 
NOIS LICENSE REQUIRED. Available now. Salary, rank open. Con- 
tact Edward A. Lichter, M.D., Prof. & Head, Dept. Prev. Med. & 
Commu. Hlth., P.O. Box 6998, Chicago, III. 60680. Phone, 312-996- 
7630. The University of Illinois is an Affirmative Action-Equal Op- 
portunity Employer and encourages applications from members of 
minority groups and women. 


Full Time Physician for Outpatient Department of Prepaid Health 
Plan. Five day 40-hr. week. No on call. Located in Central Illinois. 
New modern facility. Salary open. Tax shelter available. Contact 
administrator, Wabash Memorial Hospital Assn., 360 E. Grand, Decatur, 
III. 62525. Telephone: (217) 429-5246. 


GENERALIST for full time position in university health service; 40-hr. 
week, no on-call responsibilities; excellent community of 75,000, 
three local hospitals. Salary negotiable with liberal fringe benefits 
including 30-day vacation and retirement plan. Illinois license. Write 
or call: Margaret M. Torrey, M.D., Illinois State University, Normal, 
Illinois 61761. Phone (309) 438-8655. 


WHY FIGHT PSRO's, HMO's, AND ILLINOIS PUBLIC AID? Join us- 
minimal records, short hours, 5 weeks vacation, and 1 week medical 
meetings. Illinois University Retirement System, Health Insurance, 
and Life Insurance. Beginning salary $25,000 and negotiable. Call 
or contact Director, Health Service, EIU, Charleston, Illinois. Phone 
217-581-3013. 


INTERNIST; PRIMARY CARE PHYSICIAN; GYNECOLOGIST. Internist 

to serve as Director of Clinical Medicine; must have residency. 
Gynecologist must have residency or be a practitioner with ex- 
tensive experience in office gynecology and family planning ser- 
vices. All three must be interested in college students, new 
health care delivery systems, preventive medicine, health educa- 
tion, as well as clinic work. Salary dependent on qualifications; 
Illinois license required. Good fringe benefits, good geographical 
location. Health service has excellent modern facilities, well- 
developed x-ray and laboratory departments, etc. Equal Opportunity 
Employer. L. W. Akers, M.D., Director, University Health Service, 
Northern Illinois University, DeKalb, Illinois 60115. 


66 


Illinois Medical Journal 


BLUE SHIELD 


D 

Ll\ 


FOR 




New Blue Shield Payment Vouchers 
Ready August 30 for FEP Members 

The inaugural phase of the new payment system 
utilizing the 2-part Blue Shield Payment Voucher 
will begin on August 30 for members of the Fed- 
eral Employees Program. 

As the system is further implemented, it will 
phase-out the traditional method of Blue Shield 
payments to physicians with multiple checks for 
individual types of services, and substitute the 
8/2" x 11" computerized payment voucher that com- 
bines the physician’s check with patient records by 
date of payment. Each of five sections of the 
voucher form — patient records and check — are per- 
forated for detaching from the form. 

Checks will cover up to four patients and include 
as many as five services per patient. In each patient 
record portion, data blocks include the patient’s 
name, age, patient number, group number and 


member ID number, case number and total amount 
paid for services in the upper part; and check 
number, payment date, type of service, service date, 
place of treatment, amount billed to Blue Shield, 
portion not covered by Blue Shield, payment 
amount and payment type in the lower portion 
of each statement. 

The amount of the check to the physician is the 
total amount paid for each patient’s covered ser- 
vices. When payment is made to the physician, 
a copy of the patient’s statement portion of the 
voucher is sent to the subscriber as an explanation 
of benefits paid. 

Place of treatment, type of service and payment 
type are coded by numbers and explanations are 
given on the reverse side of the voucher. 

Payments under the new system will be made 
weekly by Blue Shield rather than daily and sub- 
stantial savings are anticipated through the reduc- 
tion in number of checks issued, with less handling 
and postage. 


Fall Workshops for Medical Assistants 

The first meeting in the fall series of workshops 
for medical assistants scheduled by the Blue Shield 
Plan of Illinois Medical Service will be held 
September 4 at Pheasant Run Inn, St. Charles. 
Workshops for medical assistants in Will-Grundy 
counties, Lake and DuPage will follow in Septem- 
ber and meetings for those in Cook County will 
be held at Plan headquarters during the month 
of October. 

Invitational letters have been sent to physicians’ 
offices in counties outside of Cook to the attention 
of the medical assistant. Letters to medical assistants 
in Cook County are scheduled to be mailed Sep- 
tember 1. 

All workshops in the fall schedule will be day- 
time meetings of morning and afternoon sessions. 
For those unable to attend morning meetings, the 
program is repeated in the afternoon. Morning 
workshops will be held from 9:00 AM to 11:30 
AM, with registration beginning at 8:30 AM. After- 
noon programs begin at 1:30 PM, following 1:00 
PM registration, and end at 4:00 PM. Compli- 
mentary luncheons will not be served during the 
fall programs but coffee “breaks” will be held 
during the morning and afternoon meetings. 

Workshop programs will be conducted by mem- 


bers of the staff of the Professional Relations De- 
partment and include discussions on the two-part 
Blue Shield payment voucher on notification of 
membership benefits paid; changes in benefits in 
Blue Shield contracts; claim filing procedures; the 
Blue Shield Reciprocity Program and State of 
Illinois Group Insurance Program. To provide as 
much discussion time as possible, participating 
medical assistants will be assigned to groups of 
approximately 25, with a member of the Profes- 
sional Relations staff serving as instructor. Special 
attention will be given to the newly-employed 
assistant. 

Workshops for medical assistants in Cook County 
will be conducted in the auditorium of the Blue 
Cross and Blue Shield headquarters building at 
233 North Michigan Avenue, Chicago. The sched- 
ule includes workshops every Wednesday and 
Thursday, beginning October 2 and ending October 
31, except Wednesday, October 16. Morning and 
afternoon workshop hours and registration times 
are the same as for the meetings outside Cook 
County: 

September Schedule 
Blue Shield Workshops 

Wednesday, Sept. 4 Pheasant Run Inn St. Charles 

Wednesday, Sept. 11 Holiday Inn South Joliet 

Wednesday, Sept. 18 Sheraton-Waukegan Waukegan 

Wednesday, Sept. 25 ' Ramada Inn Hinsdale 


(This report is a service to the physicians of Illinois) 


ASK BLUE SHIELD . . . ABOUT MEDICARE 


Optional Payment Method for Patients on Maintenance Dialysis; 
Training Payment for Self-Dialysis Patients 


Summary of New Instructions — Part I 

Instructions issued recently by the Department 
of Health, Education and Welfare to Part B Medi- 
care carriers advised that physicians may elect to 
receive payment from Medicare on a direct monthlij 
charge basis as an alternative payment method for 
services to patients on maintenance dialysis. 

Another new provision of the program allows 
physicians conducting patient training in self- 
dialysis to be reimbursed on a fat fee basis of $500 
(begun on and after July 1, 1974), per patient 
(subject to the Part B deductible and coinsurance) 
upon completion of the training course. If the 
course is not completed, payment will be made 
proportionate to the amount of time spent in train- 
ing the patient. 

Services include assessment of the patient’s home 
environment; direction of and participation in the 
training process; counseling and training of family 
members; and the review of training progress. 

Determination of Monthly Payments 

If a physician elects the monthly payment meth- 
od of furnishing services to patients on mainte- 
nance dialysis, or for home dialysis, he bills Medi- 
care monthly on the regular SSA-1490 Request for 
Medicare Payment form and receives his payment 
charge based on the following determinations and 
conversion factors: 

The monthly payment total is based on the cal- 
culated average prevailing charge for internists’ 
follow-up office visits in areas served by the carrier, 
based on 1973 charge data, multiplied by the con- 
version factor of 20 for maintenance dialysis pa- 
tients and 14 for those on home dialysis. 

Elements of Monthly Method 

(1) Payment may be made to either the physi- 
cian who accepts assignment or the beneficiary 
when assignment is not accepted. In either case 
payment is subject to the usual Part B deductible 
and coinsurance. 

(2) Physicians may elect the new method or 
continue to be reimbursed under the current 
method. 

(3) A physician may change the method of re- 
imbursement by giving the carrier written notifica- 
tion 60 days prior to termination of the agreement. 

(4) When a physician elects the monthly method 
he also accepts certain other conditions contained 
in the coverage and billing procedure. 

(5) The physician who elects the alternate 
method ( or the beneficiary in non-assignment 
cases) will be reimbursed on a basis that reflects 
variations in charges, since the conversion factor 


represents a frequency of services provided to 
maintenance dialysis patients and also includes 
specialized type of care provided when necessary 
by nephrologists. Charge screens for services are 
also reviewed and adjusted annually by the carrier 
and new methods of therapy evaluated as the pro- 
gram acquires experience. 

(6) As a requirement of treatment in a facility, 
when a physician elects the monthly reimburse- 
ment method for furnishing dialysis services all 
physicians in the facility attending renal disease 
patients must agree to the payment method. A copy 
of the agreement must also be on file at the facility 
and with the carrier. 

Services Covered 

( 1 ) Services during maintenance dialysis for 
stabilized patients are covered, whether supervisory 
or direct, in uncomplicated or complicated dialysis 
sessions. Examples would be a routine predialysis 
examination or attendance during a dialysis treat- 
ment when a patient had a serious ailment such as 
pulmonary edema. 

(2) Office visits are covered for routine evalua- 
tion of patient progress or for treatment of renal 
disease complications; also evaluation of diagnostic 
tests and procedures. 

(3) Services rendered by the attending physi- 
cian in the course of an office visit are covered. 
The primary purpose is routine monitoring or 
follow-up of complications of dialysis including 
prescribing therapy for illnesses unrelated to renal 
disease, but not exceeding the normal number of 
physician-patient contacts anticipated during the 
course of dialysis sessions or visits for treatment 
of renal complications. 

Summary Continued in Sept. Issue 

The new instructions on renal dialysis treat- 
ment and payment options issued to Part A 
intermediaries and Part B Medicare carriers are 
published at the request of the Department of 
Health, Education and Welfare. The summary 
of instructions in the August and September 
issues of Illinois Medical Journal is intended 
as information on the program to the general 
medical community. Specific details may be 
obtained from the appropriate service area in- 
termediaries and carriers. (Blue Shield for Part 
B in Cook County). 

Part II to be published in September issue 
of “Ask Blue Shield About Medicare”, will 
conclude the summary with instructions on 
Dialysis Maintenance Services Not Covered; 
Conditions for Electing the Optional Method 
of Payment and the Monthly Payment Option 
to Patients on Self-Dialysis at Home or in a 
Facility. 


(This report is a service to the physicians of Illinois) 



Illinois Medical Journal 


AUGUST, 1974 Vol. 146, No. 2 CONTENTS 


Special Articles 

91 The Heroin Problem: Some Strategic Aspects 

Edward C. Senay, M.D. and Richard J. Weinberg , B.A. 

96 Alcoholism— A General Hospital Meets the Challange 

James West, M.D. 


124 

125 


Personnel Development For the Illinois 
Emergency Medical Services System 
R. R. Hannas, M.D. 


Illinois Emergency Medical Service System Status Report III (July, 1974) 
Winifred A. Pizzano, B.A., Teresa L. Romano, B.S.N., 

John C. Nance, HMC, USN(FLT RES) and David R. Boyd, M.D.C.M. 


Clinical Articles 

101 Sensitivity Tests on Individual Human Cancers to Pick 

Active Drug Therapy 

Frances E. Knock, Ph.D., M.D., Raymond M. Galt, M.D., 

Y. T. Oester, M.D. and Robert Sylvester, B.S. 

105 Deafness and Acupuncture 

Max Sadove, M.D., Koji Okazaki, O.M.D., Sang Ik Kim, M.D., 
Man H. Lee, O.M.D., Tak Ho Liu, M.D., O.M.D. 

Ill Pediatric Perplexities: Meandering Catheter 

Vivian J. Harris, M.D. 


President’s Page 

78 Consider the Alternative 

Fredric D. Lake, M.D. 


(Contents continued overleaf) 


for August, 1974 


73 


CONTENTS (continued) 


Features 

100 New Pharmaceutical Specialties 

117 Practice Management 

121 Doctor’s News 

130 Editorials 

133 EKG of the Month 

134 ISMS Guide to Continuing Medical 
Education 

137 View Box 

137 Clinics for Crippled Children 

138 Pulse of the Doctor’s Wife 

140 Housestaff News 

141 Physician Recruitment Program 

143 Obituaries 


Staff 

Editor Theodore R. Van Dellen, M.D. 

Managing editor Richard A. Ott 

Assistant editor Joyce Gallagher 


Executive administrator Roger N. White 

(Cover by Mike Abeam) 

PUBLICATIONS COMMITTEE 

Jacob E. Reisch, M.D., Springfield, Chairman 
Eugene T. Hoban, M.D., Oak Park 
A. Edward Livingston, M.D., Bloomington 
James A. McDonald, M.D., Geneva 
Warren W. Young, M.D., Crete 


Contributor in Surgery: John M. Beal, M.D., Chicago 
Contributor in Medical Progress: Harvey Kravitz, M.D., Skokie 
Contributor in Maternal Death Studies: 

Robert Hartman, M.D., Jacksonville 
Contributor in Pediatric Perplexities: Ruth A. Seeler, M.D., Chicago 
Contributor in Radiology: Leon Love, M.D., Maywood 
Contributor in Cardiology: John R. Tobin, M.D., Maywood 


ILLINOIS STATE 
MEDICAL SOCIETY 

360 N. Michigan Ave., Chicago, 60601 

OFFICERS 

Fredric D. Lake, M.D., President 
1041 Michigan Ave., Evanston 60202 
J. M. Ingalls, M.D., President-Elect 
502 Shaw, Paris 61944 
Harold A. Sofield, M.D., 1st Vice-President 
715 Lake Street, Oak Park 60301 
Robert Hartman, M.D., 2nd Vice-President 
1515A W. Walnut Street, Jacksonville 62650 
Jacob E. Reisch, M.D., Secretary-Treasurer 
1129 S. 2nd St., Springfield 62704 

HOUSE OF DELEGATES 

Andrew J. Brislen, M.D., Speaker of the House 
6060 S. Drexel Blvd., Chicago 60637 
James A. McDonald, M.D., Vice-Speaker 
13 S. 2nd St., Geneva 60134 

TRUSTEES 

1st District: 1977, Joseph L. Bordenave, M.D. 

1665 South Street, Geneva 60134 
2nd District: 1977, Allan L. Goslin, M.D. 
712 N. Bloomington, Streator 61364 
3rd District: 1976, David S. Fox, M.D. 
20829 Greenwood Center Ct., Olympia Fields 60461 
3rd District: 1976, Robert T. Fox, M.D. 
2136 Robin Crest, Glenview 60025 
3rd District: 1975, Eugene T. Hoban, M.D. 

6429 North Ave., Oak Park 60302 
3rd District: 1975, Joseph Skom, M.D. 
707 Fairbanks Ct., Chicago 60611 
3rd District: 1977, William M. Lees, M.D. 
6518 North Nokomis, Lincolnwood 60646 
3rd District: 1977, George Shropshear, M.D. 

1525 E. 53rd St., Chicago 60615 
3rd District: 1977, Philip G. Thomsen, M.D. 

13826 Lincoln Ave., Dolton 60419 
3rd District: 1976, Frederick E. Weiss, M.D. 

15643 Lincoln, Harvey 60426 
3rd District: 1975, Warren Young, M.D. 

3450 Haweswood Dr., Crete 60417 
4th District: 1976, Fred Z. White, M.D. 
723 N. 2nd St., Chillicothe 61523 
5th District: 1976, A. Edward Livingston, M.D. 

326 Fairway Dr., Bloomington 61701 
6th District: 1975, Mather Pfeiffenberger, M.D. 

State and Wall Sts., Alton 62002 
7th District: 1976, Arthur F. Goodyear, M.D. 

142 E. Prairie, Decatur 62523 
8tli District: 1976, Eugene P. Johnson, M.D. 

P.O. Box 68, Casey 62420 
9th District: 1975, Warren D. Tuttle, M.D. 

203 N. Vine St., Harrisburg 62946 
10th District: 1975, Herbert Dexheimer, M.D. 

301 S. Illinois, Belleville 62220 
11th District: 1977, Ross Hutchison, M.D. 
126 E. Ninth St., Gibson City 60936 
Trustee-At-Large: Willard C. Scrivner, M.D. 

6600 West Main, Belleville 62223 
Chairman of the Board: Joseph L. Bordenave, M.D. 

1665 South Street, Geneva 60134 


Microfilm copies of current 
as well as some back issues 
of the Illinois Medical Jour- 
nal may be purchased from 
Xerox University Microfilm, 
300 North Zeeb Road, Ann 
Arbor, Mich. 48106. 



Contents of 1MJ are listed in the Current Contents/ Clinical Practice. 

Published by the Illinois State Medical Society, 360 N. Michigan Ave., Chicago, 111. 60601 (312-782-1654) 
Copyright, 1974. The Illinois State Medical Society. 

Subscription $8.00 per year, in advance, postage prepaid, for the United States, Cuba, Puerto Rico, 
Philippine Islands and Mexico. $10.00 per year for all foreign countries included in the Universal Postal 
Union. Canada $8.50. U.S. Single current copies available at $1.00 ($1.10 by mail), back issues $1.50. 

Second class postage paid at Chicago, 111. When moving please notify Journal office of new address 
including old mailing label with notification, if possible. POSTMASTER: Send notice on form No. 3579 to 
Illinois State Medical Society, 360 N. Michigan Ave., Chicago, 111. 60601. 

Pharmaceutical advertising must be approved by the ISMS Publications Committee. Other advertising 
accepted after review by Publications Committee or Board of Trustees. All copy or plates must reach the 
Journal office by the fifteenth of the month preceding publication. Rates furnished upon request. 

Original articles will be considered for publication with the understanding that they are contributed only 
to the Illinois Medical Journal. The ISMS denies responsibility for opinions and statements expressed by 
authors or in excerpts, other than editorial or allied views or statements which reflect the authoritative action 
of the ISMS or of reports on official actions, policies or positions. Views expressed by authors do not 
necessarily represent those of the Society; any connection with official policies is coincidental. 


cannibal stomach 



*Fordtran, J. S., and Collyns, J. A. H.: Antacid 
Pharmacology in Duodenal Ulcer: Effect of 
Antacids on Postcibal Gastric Acidity and 
Peptic Activity, New England J. Med. 
274:921-927 (April 28) 1966. 


add Pro-Banthlne 

Helps to relieve pain without risk of patient drug 
dependency. 


add Pro-Banthine 

Reduces gastric secretory volume and total 
resting and free acid without the caloric, 
digestive, and social problems occasioned by 
eating. 


Pro-Banthlne 


slows intestinal motility to 
enhance and prolong the action of 
antacids. The action of Pro-Banthlne 
lasts 4 to 6 hours. 


Searle & Co. 

San Juan, Puerto Rico 00936 


Address medical inquiries to: G. D. Searle & Co. 
Medical Department, Box 5110, Chicago, III. 60680 


SEARLE 


usually get better patient response. 


occur as well as mydriasis and blurred vision. In addition the following 
adverse reactions have been reported: nervousness, drowsiness, dizziness, 
insomnia, headache, loss of the sense of taste, nausea, vomiting, constipa- 
tion, impotence and allergic dermatitis. 

Dosage and Administration: The recommended daily dosage for adult 
oral therapy is one 15-mg. tablet with meals and two at bedtime. Subse- 
quent adjustment to the patient’s requirements and tolerance must be 
made. 

Pro-Banthine P.A. — Each tablet of Pro-Banthine PA. (propantheline 
bromide) contains 30 mg. of the drug in the form of sustained-release or 


timed-release beads: on ingestion about half of the drug is released within 
an hour and the remainder continuously as earlier increments are metab- 
olized. Thus the result is even, high-level anticholinergic activity main- 
tained all day and all night in most patients with only two tablets daily. 
Some patients may require one tablet every eight hours. 

The contraindications and precautions applicable to Pro-Banthine 15 
mg. should be observed. 

How Supplied: Pro-Banthlne is supplied as tablets of 15 and 7.5 mg., as 
prolonged-acting tablets of 30 mg. and, for parenteral use, as serum- 
type vials of 30 mg. 


389 



President’s Page 



Consider 
The Alternative 


IIIMllil 


Despite what you read in opinion polls, doctor, not everyone loves 
you. 

This observation reflects the gravest problem facing medicine to- 
day: Poor public relations. 

By public relations I am not referring to the relations engineered 
or contrived on Madison Avenue, but to the day-to-day relationship 
between you, your patients and your community. 

While public opinion polls indicate your patients may still worship 
the ground upon which you walk, many of those patients bear con- 
siderable antagonism toward your colleagues and toward the pro- 
fession at large. And, your colleagues’ patients hold similar views 
of you and the rest of the medical fraternity. 

Moreover, your patients’ rosy view of you is not monochromatic. 
While you may be respected as an astute clinician, a great diag- 
nostician or a skilled surgeon, the image is often blurred by tinges of 
indifference, callousness, arrogance and greed. 

Realistically, we must accept the fact that the kindly physician of 
yore — confidante and advisor as well as healer, always available to 
aid and comfort — has necessarily faded into oblivion in the wake of 
a scientific explosion in medicine and the parallel development of 
specialization. However, we cannot justify the shortcomings with 
which we are identified. The major complaints lodged against us 
are that we are not available when needed, keep our patients wait- 
ing, tolerate inefficient and inhospitable aides, are indifferent, over- 
charge, fail to communicate, and keep aloof from community involve- 
ment. 

The freguency and volume of these charges attest to the deplor- 
able state of our public relations — the root problem confronting our 
profession. A barrage of press releases and angry denials will not 
solve it. If it is to be resolved, each physician must recognize the 
validity of the public’s complaints, examine his methods and atti- 
tudes, and eliminate any offending characteristics. 

If you, the individual physician, fail to assume this public relations 
task, the private practitioner may be doomed to the fate of the Edsel. 




78 


Illinois Medical Journal 



The Heroin Problem: 
Some Strategic Aspects 


By Edward C. Senay, M.D. and Richard J. Weinberg, B.A./Chicago 


Heroin addiction is considered from a 
broad perspective. It is estimated, that 
0.3% of the American population is ad- 
dicted to heroin. Although heroin is not 
pharmacologically destructive, the lifestyle 
of the addict is hazardous, with an esti- 
mated death rate of about 3% per year. 
Heroin addiction may cost the country 
more than ten billion dollars per year. 

Recent experience suggests that heroin 


addiction is treatable and preventable. 
Treatment methods are revieived briefly 
with an emphasis on the use of methadone 
and therapeutic communities. Prevention 
is discussed with emphasis on the concept 
of balance; that is, the elements of treat- 
ment, enforcement, education and preven- 
tion must be coordinated with a probable 
strategic priority on youth and in particu- 
lar on polydrug using peer groups. 


Heroin addiction has become a major socio- 
medical problem in America. Reliable statistics 
have never been generated, but estimates of be- 
tween 350,000 and 700,000 active heroin addicts 
in the United States seem reasonable. 1 These 
figures imply that about 0.3% of the American 
population is addicted to heroin. It is clear that 
more and more people are becoming heroin ad- 
dicts; heroin is becoming a problem in ethnic 
and social groups in which it has not appeared 
before. An example of this trend is the growing 

EDWARD C. SENAY, M.D., is Director, 
Illinois Drug Abuse Program, Chicago, 
and Associate Professor of Psychiatry, 
University of Chicago. Dr. Senay, a 
graduate of Yale Medical School, served 
internships in internal medicine and 
psychiatry. 

RICHARD J. WEINBERG, B.A., is Ad- 
ministrative Assistant, Illinois Drug 
Abuse Program, Chicago. Previously, 
he served os a Counselor for the pro- 
gram. He is a graduate of the Uni- 
versity of Chicago. 


number of heroin addicts in middle-class suburbs. 

The death rate of heroin addicts is unknown. 
Heroin apparently is not a cumulatively toxic 
drug taken under sterile conditions, 2 but its 
illicit use is associated with risk of highly un- 
desirable efEects. 

Possible causes of death associated with its use 
include: 3 ’ 4 

1. Acutely lethal doses, from unexpectedly 
pure street heroin, from a toxic adulterant, 
from synergism with other CNS or from 
unknown causes; 

2. Embolism or thrombosis from poor hypo- 
dermic technique, or incompletely dissolved 
substances; 

3. Hepatitis, tetanus, or other fatal infections 
from non-sterile needles; 

4. Fatal pneumonia, tuberculosis, or other 
respiratory diseases not adequately treated 
because heroin supresses the cough reflex; 

5. Miscellaneous diseases not diagnosed in 
time because of the masking sense of well- 
being heroin gives; 

6. Various diseases related to poor nutrition, 




for August, 1974 


91 



unsanitary living conditions, and other ef- 
fects of economic hardship from the cost 
of heroin; 

7. Murder and violent death from the crim- 
inal lifestyle associated with the high cost 
of heroin; and 

8. Suicide related to the loss of self-esteem 
frequently associated with the “junkie” life- 
style. 

Again there are no reliable figures, but a 3% 
annual death rate is an educated guess.* This 
would mean that 10,000-11,000 people die each 
year from problems related to heroin addiction. 

The social cost of heroin addiction truly is 
appalling. The average addict spends about $30 
a day supporting his habit, or about $11,000 a 
year. 5 Assuming there are 400,000 active addicts, 
they must spend about $4.5 billion per year on 
heroin. But this is only part of the cost of heroin 
addiction. 

Few addicts can get the money they need to 
support their habits honestly. By and large, they 
get their money by stealing, postitution, dealing 
drugs, forging checks, and so on. If a robber 
steals a television set worth $200, he will be 
lucky to get $70 for it. To make $11,000 in a 
year, one must steal over $30,000 worth of mer- 
chandise. If 25% of addicts steal merchandise to 
support their habit, that adds $2 billion to the 
price tag. 

It has been estimated that over 20% of all per- 
sons arrested for property crimes are heroin ad- 
dicts. 6 Perhaps 30% of inmates of correctional 
institutions are addicts. If we charge 20% of the 
bill for police protection and 25% of the bill for 
maintaining correctional facilities to addiction, 
we add another $1.5 billion to the cost. Tire fact 
that most addicts must be criminals to support 
their habits means that about 300,000 people are 
lost from the job market, costing the country 
some $2 billion. These figures are approximate, 
but the total price tag may well be over $10 
billion. 7 

The true cost to society is not measurable in 
terms of dollars. It is estimated that 35-50% of 
all burglaries and thefts are heroin related. 8 It 
seems clear that a good deal of the rising crime 

*Statistics on all aspects of illegal activities are notori- 
ously unreliable .1 The 5% annual death rate mentioned 
in the text is based on a study at TCU . 21 This study 
evaluated the death rate of ex-addicts in treatment pro- 
grams, and found that while the median age of patients 
was 25, the annual death rate was 1.5%. We have assumed 
this rate doubles for addicts not in treatment. Although 
common estimates are lower, these estimates are method- 
ologically weak. Some even give higher pgures.22 


rate is directly attributable to this. The destruc- 
tive effect of such crime is unmeasurable, but 
obviously substantial. In other words, heroin ad- 
diction is a major contributing factor in the high 
crime rate, which may be the greatest public 
concern today. 

Current strategic thinking divides the problem 
into two broad areas dealing with the addict, 
treatment and prevention. 

Treatment 9 

Until recently, there was no effective treatment 
of heroin addiction. This has radically changed 
with the work of Diederich, and that of Dole and 
Nyswander. Diederich founded Synanon, the 
prototype of drug abuse therapeutic communi- 
ties. These therapeutic communities, of which 
there are now over 100, are generally operated 
on a common set of principles. They are long 
term residential facilities, which try to sub- 
stitute dependence on people for dependence on 
drugs. The counselors in such facilities are pre- 
dominantly ex-addicts. In the process of rehabili- 
tation the addict is required to attend group 
sessions— typically encounter groups; as therapy 
progresses, as measured by behavior and length 
of time in treatment, he is rewarded by being 
given more responsibilities in the house, greater 
esteem by his peers, and more privileges. These 
rewards may be taken away for “negative be- 
havior” such as infractions of house rules. 

The therapeutic community is quite successful 
with a certain percentage of addicts. People who 
remain in treatment have a low recidivism rate, 
are highly motivated to achieve, and may act as 
“anti-drug users,” either by personal contact, or 
as employees of drug abuse programs. On the 
other hand, therapeutic communities are expen- 
sive, and relatively few patients complete treat- 
ment. Therapeutic communities are probably 
the treatment of choice for perhaps 10% of 
heroin addicts. 

Dole and Nyswander developed methadone 
maintenance, in which an addict is given a daily 
dose of methadone, a synthetic opiate, as a sub- 
stitute for heroin. 10 They found that methadone 
reduces the craving for heroin and blocks the 
effects of using heroin. A high percentage of 
addicts given methadone stop using heroin. 

It now appears that methadone can be only 
part of a successful treatment modality. 11 To op- 
timize success rates, a methadone maintenance 
clinic must provide non-chemical sources of sup- 
port, such as counseling, vocational rehabilita- 
tion, job placement, legal services and medical 


92 


Illinois Medical Journal 


services. Such clinics have some success with at 
least one out of two patients, success being mea- 
sured in terms of patient retention, reduction or 
elimination of illicit drug use, and reduction or 
elimination of illegal activity. 12 

The advantages of methadone maintenance are 
high patient acceptability, high retention rate, 
and low cost. The primary disadvantage is that 
methadone is an addictive drug, and the pos- 
sibility is always present that someone who is 
not an addict, or who would otherwise stop tak- 
ing drugs altogether, may become addicted to 
methadone. Methadone maintenance is the cur- 
rent treatment of choice for long term opiate ad- 
dicts with low to moderate motivation for change. 

Psychotherapy has had a fairly poor record in 
addict populations. Although some addicts have 
recovered with psychotherapy alone, it is a long, 
painful process with low success rate. It is pro- 
hibitively expensive for most people. 

Various religious sects have reported substan- 
tial success in rehabilitating addicts, notably the 
Black Muslims and the Pentecostal Church. Ap- 
parently, the rehabilitative process within these 
sects is similar to that of therapeutic communities 
—they provide a powerful emotional substitute 
for drugs. Although the overall rehabilitation 
rate is rather low, it may be the treatment of 
choice for certain motivated addicts with strong 
religious background. 

Dr. Jerome Jaffe pioneered the “multi-modal- 
ity” approach to drug rehabilitation. 13 An unfor- 
tunate tendency of exclusionism exists in many 
treatment programs— “Our is the one true way.” 
In Illinois we have found that modalities need 
not be mutually exclusive. It appears that best 
treatment results come when addicts are offered 
a variety of different rehabilitative options. 

Prevention 

Much of the work in preventing heroin addic- 
tion is not immediately recognizable as such. 
Paramount in this category are the set of laws 
regulating narcotics and the efforts of police and 
customs authorities to stop the flow of opiates 
and to imprison so-called “pushers.” Obviously, 
restricting availability of narcotics through the 
laws concerning legal dispensation of opiates has 
done some good. At the turn of the century, large 
segments of the population, especially middle- 
aged housewives, used various patent medicines 
containing opiates. 14 Although the people who 
became addicted this way often continued to use 
opiates despite legal sanctions, the modern mid- 


dle-aged housewife is very seldom an opiate 
addict. 

Police and customs work has failed to elimi- 
nate heroin from America, and there is consid- 
erable evidence that it cannot. 15 However, by 
making heroin more expensive and less accessible 
than it might otherwise have been, this effort has 
probably prevented many people from becoming 
addicts. Much of the frustration attached to po- 
lice narcotics work is due to the desire to deter 
addicts from using drugs. If we could perceive 
this work as designed to reduce the incidence of 
new addiction, rather than to eliminate estab- 
lished addictive behavior, we cotdd be more 
optimistic about the situation. In light of this, 
more emphasis should be placed on controlling 
heroin distribution, and less on arresting or 
harassing the confirmed addict; but probably 
police work is about as effective as it can be. We 
should note in passing that about 50% of those 
ordinarily described as addicts at least occas- 
sionally “push” drugs. 16 But as is the case with 
all other attempts to ameliorate the drug prob- 
lem, the enforcement effort suffers from its fail- 
ure to be part of a coordinated strategy. 

We have recently seen a good deal of effort 
put into drug education, school programs, TV 
commercials, posters, and so on. The hypothesis 
is that education about the dangers of drug abuse 
will reduce the incidence of new cases. Although 
this hypothesis may be true, results to date have 
been disappointing. Much of the work has been 
poorly designed, poorly thought out, and com- 
pletely unevaluated. While drug education may 
be worthwhile in itself, education as prevention 
needs a good deal more careful study before full- 
scale implementation should be considered. 

1’he context in which education occurs prob- 
ably is as important as the content of the educa- 
tional attempt. Education might have a powerful 
effect if it occurred as an element in an overall 
drug strategy, but to date we do not know what 
could be achieved because of the fragmentary 
nature of our strategic thinking; current educa- 
tion efforts have not been coordinated with other 
elements in the attack on the problem. 

There are identifiable conditions conducive to 
addiction, and while many of these are quite 
difficult problems indeed, it is worthwhile at 
least to consider them. The American culture has 
become drug oriented. We are urged to take a 
pill to solve problems ranging from insomnia, to 
anxiety, to depression and fatigue, to difficulties 
with in-laws. There may be a tendency among 
doctors to over-prescribe medication for minor 


for August , 1974 


93 


ailments. Medicine has become a panacea and 
ritual object. We see some effort to change this 
tendency— more responsible advertising, greater 
caution by doctors in prescribing, and so on, but 
we have a long way to go in this area. Anti-drug 
propaganda could and should be a component 
in a balanced and comprehensive attack on the 
drug problem. 

Also, we note that such things as vehicles, com- 
munications, ideas, values, people, move faster 
now than ever. The sensory input a person must 
deal with in a day has grown at an enormous 
rate. Along with this is a certain lack of stabil- 
ity. Our -deepest values are questioned. The fam- 
ily unit is weakening, with no substitute source 
of emotional stability available. These facts of 
modern life possibly create more anxiety, anomie, 
and tension, and may lead to more ulcers, heart 
attacks, suicides, and drug addicts. We do not 
pretend to offer a solution to these problems, but 
a reasoned approach to even these complex prob- 
lems is conceivable and should be a part of the 
overall attack on drugs. 

We also know that poverty, racism, unemploy- 
ment and other social problems endemic in our 
central cities are associated with drug addiction. 
These problems are theoretically solvable, and 
we need to include consideration of them in any 
strategy on drugs. Methadone alone, for example, 
is a short term solution in some ghettos and 
barrios, but we had better present a package of 
methadone plus jobs and educational oppor- 
tunities if we want real progress in the war on 
drugs. 


The Use of Heroin 

We have learned a great deal in the past five 
years; such as knowing that addicts are almost 
never introduced to heroin by the mythical 
school yard dope peddler. People are offered 
heroin by their friends and peers. 17 Heroin use 
typically starts out as an adolescent dare. Epide- 
miological studies suggest that heroin spreads 
within groups— either friendship groups, in the 
case of micro-epidemics, or whole communities, 
in the case of macro-epidemics. 18 Within the 
group, the heroin addict is a respected member 
who enjoys high status. Apparently heroin spread 
requires both a supply of active users and a sub- 
culture in which drug use is perceived as de- 
sirable. 

ft is apparent that heroin use is correlated to 
the prior use of other illegal drugs. What has not 


been fully explained is the nature of this rela- 
tionship. The naive conclusion that the use of 
marijuana, amphetamines, barbiturates, and 
other drugs causes a person to use heroin is a 
gross oversimplification. The use of these non- 
opiate drugs defines a subculture— the “polydrug” 
subculture, ft is much more likely for a person 
to be introduced to heroin if he is already in the 
polydrug subculture than if he has never used 
drugs. This in no way means that polydrug use 
causes heroin use but rather that many heroin 
addicts are recruited from the polydrug sub- 
culture. 19 

The existence of heroin in America despite 
all the best efforts of the police, customs, and 
federal narcotics agents to the contrary, is elo- 
quent testimony to the intense craving of the 
addict, the enormous profits in the heroin black 
market, the power and ingenuity of heroin smug- 
glers, and the relative ease of smuggling a few 
tons of contraband into the country each year. 
The single most effective way to close a black 
market may be to eliminate consumer demand; 
that is, to rehabilitate addicts. 

Some of the points in the preceding para- 
graphs became clear to us in the course of our 
work with heroin epidemics. 20 In 1970 a sizable 
heroin outbreak was identified in a relatively 
isolated Chicago community of 15,000. Prelim- 
inary investigation revealed about 100 heroin 
addicts in this community, almost all of whom 
had become addicted after 1966. In 1971 we 
opened an intensive community-based rehabilita- 
tion program. Most of the addicts came into 
treatment and most of the remainder moved out 
of the community. Heroin has been relatively un- 
available within the community since January, 
1972. On the basis of this experience, it is sug- 
gested that if a metropolitan area made an all- 
out effort to implement well-structured drug 
programs that were accessible to the entire 
population, not only wotdd few addicts remain, 
but few new addicts would appear. In other 
words, we should try making massive strikes on 
defined areas rather than continuing to dribble 
our limited resources over too many areas. 

Summary 

To summarize some of the important lessons 
which should determine the drug strategy for the 
70’s: 

• There is no reason for apathy. We don’t 
know all we might about rehabilitation. 
There is still a need for research. But we 


94 


Illinois Medical Jou. nal 


do know enough to take decisive action 
against heroin, provided we have the will. 

• Heroin addiction is spread by friends, not 
pushers. In the drug subculture, heroin is 
considered “good,” not “bad,” and as such 
is something offered to friends, not strang- 
ers. Most “pushers” will not sell to a strang- 
er, who might be a policeman. 

• If treatment is available, convenient, and 
offered in an acceptable form, many addicts 
use it. In a pilot project, about 80% of 
addicts in a community voluntarily sought 
treatment when a treatment center opened 
in their community. 

• To be successful, a treatment program must 
include representatives from the community 
it wants to serve, both in planning and im- 
plementation. 

• Community and neighborhood groups must 
play an active role in focusing the com- 
munity’s attention on drug abuse and defin- 
ing the community’s relationship to the 
treatment center. 

• Jobs, adequate housing, and similar basic 
needs must be available to those addicts who 
seek rehabilitation. An addict’s drug prob- 


lem is only part of a constellation of prob- 
lems making him feel helpless and hopeless. 

• Any drug program must be accountable to 
recognized principles of professional prac- 
tice, and to the community in which it op- 
erates. 

Finally, we need an explicit, comprehensive, 
balanced strategy on federal, state, and local lev- 
els. The strategy should attack different aspects 
of the problem in a coordinated sequence. It 
almost certainly should aim its main force at the 
polydrug-using youth subculture as the main 
target for prevention, since this group represents 
the largest pool of illicit drug users. 

W e have the resources and the know-how to re- 
duce greatly the severity of the problem of chem- 
ical dependence in our society. Somehow we need 
to synthesize the knowledge and skills available 
in order to become even more aggressive about 
what was once thought to be an unsolvable 
problem. ◄ 

References 

A complete bibliography for “The Heroin Problem: 
Some Strategic Aspects” may be obtained by writing to 
the Illinois Medical Journal, 360 N. Michigan Ave., Chi- 
cago, 60601. 


Conference Workshop On 

DRUG and ALCOHOL DEPENDENCIES 


October 4, 1974 
Ramada Inn, 
Bloomington, III. 

Physicians, school nurses, school 
counselors, school administrators, 
allied health personnel, emergency 
department personnel, pharma- 
cists, enforcement (youth) officers, 
community workers and interested 
persons are invited to attend one 
or both days of the workshop. 


October 5, 1974 
Union, Illinois State University, 
Normal, III. 

Subjects to be discussed include: 

The Abusive Substances Problem 
in the Schools 

The View of Enforcement Officials 
Teaching About Dependencies 
What To Do Until The “Doctor Ar- 
rives 

Drugs and the Law 
What is Dependency? 


Advance registration will be accepted until September 27, 1974. For information, write or phone, Illinois 
State Medical Society, Division of Scientific Services, 360 N. Michigan Ave., Chicago 60601; 312-782-1654. 


for August, 1974 


95 


Alcoholism — A General Hospital 
Meets The Challenge 

By James W. West, M.D./Evergreen Park 


The program at Little Company of Mary Hos- 
pital, Evergreen Park, for the care of alcoholism 
patients can serve as a model for any general hos- 
pital. The prevalence of alcoholism accounts for 
about 30% of all general hospital admissions. Al- 
though the primary diagnosis for these patients 
may not be specified as “alcoholism,” the reason 
for hospitalization is usually related to alcohol 
use. 

There are three important factors which 
have emerged in our society to hasten our di- 
rectly addressing the responsibility for the care of 
the alcoholism patient. These factors include, 
firstly, “Legal Power” which has residted in the 
Uniform Practice Act removing the inebriate 
from the criminal justice system making him a 
responsibility of the health care system. In addi- 
tion, there have been successful malpractice liti- 
gations for refusal to treat the alcoholic patient. 

Secondly, there is “Green Power,” money, pro- 
vided by health insurance carriers, who, by law, 
must cover the treatment of alcoholism as new 
insurance contracts are written. In addition, Fed- 
eral legislation provides $375 million in the next 
two years for both alcoholism care and the train- 
ing of health care professionals. 

Thirdly, there is “People Power,” a new at- 
titude by the public about this sickness. Educa- 
tional information has helped people recognize 
alcoholism as an illness for which they expect the 
best possible treatment as they do with any other 
sickness. 

At Little Company of Mary Hospital, a plan 
was put into operation which provides care for 
the acutely ill alcoholism patient and initiates 
his long term recovery through a system of in- 
patient services and effective after-care referral 
relationships. This program functions with the 
support and participation of Administration, 

JAMES W. WEST, M.D., serves on the Illinois State Medical 
Society Committee on Alcoholism and Drug Dependence. He is 
affiliated with the Department of Psychiatry, Rush-Presbyterian- 
St. Luke's Hospital, Chicago; Assistant Professor, Department of 
Psychiatry, Rush Medical College; and Assistant Director, De- 
partment of Surgery, little Company of Mary Hospital, Evergreen 
Park. 

Editor’s Note: See Guest Editorial, page 131 on Model 
Cities— CCUO’s Alcoholism Recovery and Rehabilitation 
Program. 


Medical Staff, Nursing Services and the Depart- 
ment of Patient and Family Counseling. 

The start of the program at Little Company 
of Mary Hospital was preceeded by a period of 
inservice training, participated in by emergency 
care personnel and members of the Nursing Ser- 
vices Department. The training program includ- 
ed lectures and discussions about the nature of 
the disease and a review of its spectrum of treat- 
ment. Attitudes of the treatment personnel were 
particularly stressed. Bedside teaching of nurses, 
residents and interns and frequent review of 
each patient’s responses to treatment is an in- 
trinsic part of the program. 

Patients are admitted to the hospital with the 
diagnosis of “alcoholism -acute withdrawal syn- 
drome.” The patients are placed on the medical 
service and their treatment is reviewed, as with 
other illnesses, by the Department of Internal 
Medicine. 

The treatment program in this hospital is an 
organized multidisciplinary diagnostic and ther- 
apeutic system. The admitting physician retains 
i he primary responsibility for the care of the 
alcoholism patient, but shares the treatment ef- 
fort with a team of professionals who participate 
in the various aspects of the recovery procedure 
process. The sophisticated medical back-up sys- 
tems are entirely adequate to properly serve the 
acutely ill alcoholism patient in the community. 
A long-term alcoholism rehabilitation unit, or an 
isolated unit for the care of the short-term alco- 
holic, is not necessary. The hospital can meet its 
community needs without the addition of any 
medical beds by treating acute alcoholism pa- 
tients in the regular medical beds without isolat- 
ing (Item from other medical patients. Adequate 
medical management makes this system of patient 
distribution practical. Empathetic and informed 
nursing care along with adecpiate medication 
have proven this system to be feasible by a large 
experience. 

The actual system of care begins with the 
emergency room procedures. Transportation of 
the patient is usually by police vehicle or private 
auto. Upon arrival, immediate care of the pa- 
tient is begun with the triage process wherein the 
diagnosis is made, the urgency of the patient’s 


96 


Illinois Medical Journal 


condition is determined and the type of care is 
assigned. 

At Little Company of Mary Hospital, urgency 
of care is determined by assessing which stage of 
acute withdrawal from alcohol exists. A person 
who is merely intoxicated, but not suffering from 
withdrawal symptoms, is usually not in need of 
hospital admission unless there is some additional 
pathologic process which might be aggravated 
seriously by the alcohol. 

The phases of withdrawal from alcohol are 
(he conditions which are potentially health or 
even life threatening. These conditions invariably 
follow prolonged ingestion of large amounts of 
alcohol. The emergency department uses the 
following staging system in processing the acute 
alcoholism patient: 

Stage I consists of psychomotor agitation (the 
“shakes”) , autonomic hyperactivity (tachycar- 
dia, hypertension, hyperhidrosis and anorexia.) 

Stage II consists of hallucinations— these are 
auditory, visual or tactile: there may be one or 
a combination of these. The hallucinatory ex- 
perience is usually frightening and there is usual- 
ly an amnesia for details of this experience. How- 
ever, the patient is oriented as to time, place and 
person. 

Stage III consists of delusions, disorientation, 
delirium, plus all of the above, with severe psy- 
chomotor agitation. This may be intermitent, but 
is always followed by amnesia. 

Stage IV consists of convulsive seizure activity. 

The management of the patient is determined 
by the stage of the acute withdrawal syndrome 
that exists. Usually, the Stage I withdrawal pa- 
tient may be discharged with a mild medication 
and be followed in an out-patient treatment set- 
ting. The usual medication used for this situa- 
tion is hydroxyzine (Vistaril®) , in modest 
amounts, and a one day supply to be renewed 
by the physician at the outpatient clinic when 
the patient returns the next day. This stage may 
be unpredictably progressive so, if a patient gives 
a history of having previously experienced seiz- 
ures during withdrawal, he is admitted for a 24 
to 48 hour period. Seizures show a 70% recur- 
rence rate with each withdrawal experience. 

Since hallucinatory activity of Stage II fre- 
quently proceeds to the next and much more 
serious Stage III, these Stage II patients are ad- 
mitted to the hospital. Both Stage II and Stage 
III are treated with adequate sedation to control 
the psychomotor agitation and a neuroleptic 
agent (chlorpromazine [Thorazine®], or halo- 
periodol [Haldol®]) to manage the hallucinatory 


phenomena. The Stage III patient is usually very 
ill. This state has been traditionally described as 
the D.T.’s. Stage III is rarely due to alcohol 
alone; trauma, infection, multiple drug use, hy- 
povolemia or electrolyte imbalance are usually 
also present. 

Stage IV acute withdrawal states are charac- 
terized by seizures which are controlled by dia- 
zepam (Valium®) , or some other anticonvulsant 
agent. Sodium diphenylhydantoin (Dilantin So- 
dium) is not effective for about 72 hours. 

This method of emergency room staging has 
made the processing of the acutely ill alcoholic 
a more effective procedure. All of the physicians 
and the nurses in the Emergency Department are 
familiar with the diagnostic criteria of this sys- 
tem. Appropriate treatment starts in the Emer- 
gency Room consistent with the exact nature and 
urgency of the condition. 

Those Stage II, III, and IV patients, all of 
whom are admitted to the hospital, are given 
medication while still in the emergency room. 
When the patient exhibits an intense psycho- 
motor state, he is usually held in the emergency 
area until he responds to the medication. 

All persons who are admitted do so voluntarily. 
When there is an acute bed shortage, Stage I and 
Stage II patients are referred to other hospitals 
where arrangements have been made to accept 
these referrals. 

Admission procedures include using the diag- 
nosis of “acute alcoholism— withdrawal syn- 
drome.” The patients are admitted to the medical 
areas where they are placed with the other medi- 
cal patients. The additional use of medication 
has effectively eliminated the use of physical re- 
straints, except in the rare and short term use 
of a waist Posey belt in the Stage III patient. A 
set of standing orders, which have been the focus 
of inservice training, gives the nursing personnel 
the use of sedation as they see the need for the 
patient. Although there are many effective drugs 
for use in the withdrawal syndrome, one drug 
has been chosen so that all those who administer 
it can become familiar with its effectiveness and 
its limitations. This chug chlordiazepoxide (Lib- 
rium®) has had wide use and its limitations and 
safety features are well known. After the patient 
has recovered from the acute withdrawal syn- 
drome, he is taken off all sedation. Occasionally 
he may continue the use of a neuroleptic or an 
anticonvulsant drug if this is indicated. If a pa- 
tient suffers from concommitant physical disor- 
ders, they are treated simultaneously with the 
withdrawal therapy. 


for August, 1974 


97 


Three considerations in the treatment of the 
acute withdrawal syndrome should be mentioned. 
These are, effects of withdrawal on 1) central 
nervous system, 2) fluid and electrolyte balance, 
and 3) abnormal glucose metabolism. 

The central nervous system demands immedi- 
ate attention in the form of adequate sedation to 
combat the psychomotor activity. This condition 
is probably due in part to an increase in intra- 
cellular sodium and a decrease in intracellular 
potassium brought about by alcohol and its ef- 
fect on mitochondria produced ATPase. This 
enzyme, a necessary part of the active transport 
system within the cell membrane, keeps the sodi- 
um and potassium ratio in a correct state. An 
abnormal ratio reduces transcellular membrane 
potentials thus increasing excitability of nerve 
and muscle tissue. Sedation controls this condi- 
tion of tissue excitability, and abstinence from 
alcohol usually restores transcellular electrical 
gradients within a day or two of treatment. 
Dilantin Sodium is given to those patients who 
have seizures or who have a history of seizures. 
This is given with phenobarbital for the first 72 
hours, after which Dilantin Sodium can be given 
alone. Dilantin Sodium affects cell membrane 
physiology by decreasing intracellular sodium 
and increasing intracellular potassium, thus ef- 
fectively counteracting one of the most prominent 
causes of psychomotor hyperactivity in alcohol 
withdrawal. 

Fluid balance, contrary to traditional beliefs, 
is in a state of overhydration. Only when the 
blood alcohol level is rising is the antidiuretic 
hormone of the posterior pituitary suppressed 
producing a diuresis, mostly a free water clear- 
ance with some magnesium loss. The other elec- 
trolytes, sodium, potassium and chloride, are re- 
tained. There is retention of water and electro- 
lytes after the blood alcohol level reaches a 
plateau, which is usually early in a drinking epi- 
sode. Thus, when the patient is admitted to the 
hospital, he is in positive water balance and, be- 
cause he has also retained his electrolytes, he is 
in a state of iso-osmotic overhydration. Unless 
the patient has been vomiting, or has had a diar- 
rhea, intravenous fluids are contraindicated. The 
patient can usually tolerate orally whatever fluids 
he needs. Diuresis occurs shortly after withdrawal 
from alcohol has started, which restores fluid 
and electrolyte balance to normal levels. Magne- 
sium levels may be low, but replacement by 
IM. solution has not been done on this program 
since its value is controversial. 

Abnormal carbohydrate metabolism is asso- 


ciated with labile blood glucose levels. Alcohol 
depletes hepatic glycogen stores, impairs gluco- 
neogenesis, and produces an occasional hypogly- 
cemia of such a low level as to produce seizure 
activity. Blood sugar levels are followed carefully 
for the first four days. 

Other conditions which demand careful watch- 
ing are infections, possible trauma, or other 
physical conditions which, in common with the 
acute withdrawal state, can precipitate a sudden 
Stage III condition with delusion, delirium, hal- 
lucination and other signs recognized traditional- 
ly as the D.T.s. There are some warning signals 
for this stage of withdrawal which the alert phy- 
sician or nurse can recognize and treat promptly. 

Standing orders, which are meant to serve as 
a grade and base line procedure, have been re- 
viewed with all the personnel who will deal with 
the patient. These standing orders have served a 
large number of patients and they are designed 
to be modified to meet the individual needs of 
each patient. 

The following is the order sheet for patients 
admitted for acute alcoholism: 


ADMITTING DIAGNOSIS: 


Acute Alcoholism 

Acute Withdrawal Syndrome— Alcohol 

Other Medical or traumatic conditions if present 


ADMISSION ORDERS: 
STAT 

CBC 

Urinalysis 

Blood Drug Screen 

Glucose 

Blood Alcohol 

Chest X-ray 

Electrolytes 


LABORATORIES: 
DRAW IN AM., 
FOLLOWING DAY 
SMA 12/60 
S.I.C.D. 

S.G.P.T. 

Triglycerides 
Coagidation Survey 
ECG 

Bland or General Diet as 
tolerated 


MEDICATIONS AND NURSING: 


Start in Emergency Department 

1. Inj. Librium® 50 mg. IM. STAT: and 50 mg. of 
Librium >i may be repeated every one/half hour 
if patient is very restless. 

2. Inj. Librium® 50 mg. IM. every 3 to 4 hours; but 
do not awaken patient if asleep. 

(This dosage to be changed as indicated) 

3. Inj. Sodium Amytal® gr. iii IM. at about 10:00 
p.m. for sleep if necessary. 

4. Inj. Thiamine Hydrochloride® 200 mg. IM. b.i.d. 

5 Take Berminal “500”® (i) b.i.d. 

6. Have relative remain with the patient after pa- 
tient reaches the floor until nurse indiates this is 
no longer needed. 

7. Do not use restraints. 

8. Notify physician about admission and patient’s 
condition and call physician's resident or intern. 

9. Observe patient closely for any rise in temperature, 
or profuse perspiration, or hallucinations, as these 
signs may indicate impending Stage III With- 
drawal. Notify physician or his resident. 


98 


Illinois Medical Journal 


10. Daily therapy sessions at 1:45 p.m. in North 
Pavilion. Room 226, Patient and Family Counseling 
Department. 

11. A. A. Meetings on MONDAY, WEDNESDAY, FRI- 
DAY EVENINGS. 8:00 p.m. (MONDAY AND FRI- 
DAY in Meeting Room “B”— Wednesday in Board 
Room) 

12. Further workup as indicated. 

13. Notify Alcoholism Program Coordinator of pa- 
tient’s admission. 

Psychosocial therapy begins on admission of 
the patient to the emergency care system. This 
starts with the same caring and accepting attitude 
as the nurse or physician would have with any 
other kind of illness. The patient is assured of 
help and relief by personnel who understand 
that their approach is effective in allaying fears 
and damping psychomotor agitation. 95% of 
alcoholism patients enter psychosocial treatment 
by way of some physical or acute social crisis. 
Their initial contact with the helping profession- 
al may set the direction of their eventual recovery 
process. 

At Little Company of Mary Hospital the psy- 
chosocial therapy begins on admission and con- 
tinues throughout the patient’s stay. The physi- 
cian counsels daily with the patient, outlining the 
physical effects of alcohol use and helping to 
plan goals for rehabilitation. An alcoholism pro- 
gram coordinator sees each patient soon after 
admission and daily thereafter, explaining the 
alcoholism program, providing literature and dis- 
cussing the Alcoholics Anonymous and Alanon 
programs. The patient’s family is involved in the 
program by introduction to Alanon groups. 

Group Therapy 

Group therapy has been found to be the most 
effective alcoholism treatment modality and the 
patient is introduced to this as soon as he is 
physically able to attend. Some patients are 
brought by wheel chair to the daily sessions. This 
therapy consists of didactic sessions given by a 
physician covering the physical effects of alcohol 
use. Group psychotherapy, conducted by trained 
alcoholism therapists, uses the orthodox psycho- 
therapeutic techniques including transactional 
analysis, group process, communication and some 
psychodrama. Alcoholics Anonymous meetings 
take place on three evenings a week at the hos- 
pital and are participated in by the patients and 
community members of A.A. Film presentations 
on alcoholism for staff and patients are shown 
and discussed. These films are produced by the 
American Hospital Association and are provided 
by the South Suburban Council on Alcoholism 
as a service to the community. A workshop group 


takes place on Saturday for patients and ex-pa- 
tients. The goal of this session is insight develop- 
ment, particularly as it pertains to alcoholism in 
the patient’s life and family. Alanon groups for 
spouses of patients meet on the hospital campus 
once a week. 

Psychometric testing is done on those patients 
designated as needing this by the physician. 
These include the Bender-Gestalt, the Shipley- 
Raven Matrix and the M.M.P.I. tests. Psychiatric 
consultation is available and used on very de- 
pressed and otherwise psychiatrically disturbed 
patients. Some psychiatrists have referred their 
alcoholism patients to the alcoholism program in 
the medical section. They thus conserve the psy- 
chiatric beds for their patients who require con- 
fined care. 

After-care is an essential component of any ac- 
ceptable alcoholism program. This consists of di- 
recting and following, or referring, the patient 
for continuing alcoholism therapy, the intensity 
of which is dependent on the individual need. 

At Little Company of Mary Hospital, the acute 
care program is necessarily of short duration. As 
soon as the patient is no longer in need of phys- 
ical treatment, he is directed into the after-care 
system. While in the hospital, he is introduced to 
the psychosocial system of therapy in which he 
will hopefully participate for the rest of his life. 
This kind of treatment addresses itself to the 
disease, alcoholism. 

The process of after-care begins with the pa- 
tient calling the local A.A. office on the day be- 
fore discharge. This assures that members of A.A. 
in the patient’s community will contact the pa- 
tient and bring him to the local A.A. group 
meetings after he is discharged from the hospital. 
Arrangements are also made for outpatient coun- 
seling with the professional people who run the 
hospital group therapy sessions. The Department 
of Patient and Family Counseling provides fam- 
ily and patient counseling to those who need this 
service. During the hospital stay, the social work- 
er for the alcoholism program works with the 
patient to solve those problems that the individ- 
ual may present as part of his total alcoholic 
career. Some of these patients brought in by 
police are in need of post-hospital living ac- 
commodations or nursing home care. 

There are some patients who are in need of 
longer inpatient care in the form of rehabilita- 
tion. These patients are transferred to one of 
the excellent rehabilitation centers in the city 
for a continuation of the psychosocial therapy to 
(Continued on page 136) 


for August , 1974 


99 



new 

ptiarmaceutical 



For detailed information regarding indications, dosage, 
contraindications and adverse reactions; refer to the man- 
ufacturer’s package insert or brochure. 

Single Chemicals— Drugs not previously known, includ- 
ing new salts. 

Duplicate Single Drugs— Drugs marketed by more than 
one manufacturer. 


asthma and pulmonary diseases. 

Contraindications; Pre-existing cardiac arrhythmias 

associated with tachycardia 

Dosage: Acute— 1 to 2 inhalations 

Maintenance— 1 to 2 inhalations 
4 to 6 times daily. 

Supplied: Aerosol, measured dose supplies 

0.075 mg. 


Combination Products— Drugs consisting of two or more 
active ingredients. 

New Dosage Forms— Of a previously introduced product. 

The following new drugs have been marketed : 


SINGLE CHEMICALS 


BRICANYL 

Manufacturer: 

Nonproprietary Name: 
Indications: 

Contraindications: 

Dosage: 

Supplied: 


Bronchodilator Rx 

Astra Pharmaceutical Products, 
Inc., Worcester, Mass. 
Terbutaline Sulfate 
Bronchial asthma and reversible 
bronchopasm occurring with 
bronchitis and emphysema. 
Known hypersensitivity to symp- 
athomimetic amines. 

0.25 mg. subcutaneously into the 
lateral deltoid area; additional 
doses according to package in- 
sert. 

Ampules, 2cc, cc/1 mg. 


CEFADYL 

Manufacturer: 
Nonproprietary Name: 
Indications: 

Contraindications: 

Dosage: 

Supplied: 


Broad Spectrum 

Antibiotic Rx 

Bristol Laboratories 

Cephapirin Sodium 

Infections caused by susceptible 

organisms. 

Known allergy to cephalosporins 

See package insert 

Vials, 1 Gm., for i.m. or i.v. inj. 


MONISTAT 

Manufacturer: 
Nonproprietary Name: 
Indications: 

Contraindications: 

Dosage: 

Supplied: 


Topical Fungicide Rx 

Ortho Pharmac. Corp. 
Miconazole nitrate 
Local treatment of vulvovaginal 
candidiasis (moniliasis) 
Hypersensitivity 

One applicatorful once daily at 
bedtime 

Water miscible cream, 2% 


DUPLICATE SINGLE DRUGS 

LUF-ISO Bronchodilator Rx 

Manufacturer: Mallinckrodt Pharmaceuticals 

Nonproprietary Name: Isoproterenol sulfate 

Indications: Bronchospasms associated with 


COMBINATION PRODUCTS 


DIBAN 

Manufacturer: 

Composition: 

Indications: 

Contraindications: 

Dosage: 

Supplied: 


Antidiarrheal Rx 

A. H. Robins Company 
Powdered opium 12 mg. 
Atropine sulfate 0.24 mg. 
Symptomatic control of acute 
and nonspecific diarrhea. 
Pyloric obstruction, glaucoma, 
and urinary tract obstruction. 

2 tablets initially followed by 1 
or 2 tablets every three to four 
hours as needed. 

Tablets 


TROJACILLIN-PLUS 

Manufacturer: 

Composition: 

Indications: 

Contraindications: 

Dosage: 

Supplied: 


Penicillin Combination Rx 
Holland-Rantos Co., Inc. 
Ampicillin 3.5 Gm. 

Probenecid 1.0 Gm. 
Uncomplicated infections of N. 
gonorrhea 

Susceptibility to penicillins 
Single dose of both drugs 
Unit dose bottle 


VISTRAX 

Manufacturer: 

Composition: 


Indications: 

Contraindications: 

Dosage: 

Supplied: 


Antispasmodic Combination Rx 
Pfizer Laboratories 
Oxyphencyclimine Hydroxyzine 
HC1 HC1 

5 mg. 25 mg. 

10 mg. 25 mg. 

Adjunctive therapy in peptic 
ulcer 

Glaucoma, obstructive uropathy 
and obstructions of the g.i. tract 
One tablet b.i.d. or t.i.d. 

Tablets 


NEW DOSAGE FORMS 


SINEQUAN ORAL 
CONCENTRATE 

Manufacturer: 
Nonproprietary Name: 
Indications: 

Contraindications: 

Supplied: 


Tranquilizer and 
Psychostimulant Rx 

Pfizer Laboratories 
Doxepin HC1 

Mixed symptoms of anxiety and 
depression 

Glaucoma, urinary retention and 
hypersensitivity to the drug. 
Bottles, 120 mg., cc/10 mg. M 


100 


Illinois Medical Journal 


Sensitivity Tests on Individual Human 
Cancers to Pick Active Drug Therapy 


By Frances E. Knock, Ph.D., M.D., Raymond M. Galt, M.D., Y. T. Oester, M.D. 
and Robert Sylvester, B. S./Chicago 


Sensitivity tests on human cancers can rule out inactive drugs for clinical treat- 
ment with 100 % accuracy. In our laboratories and in studies throughout the 
world, correlations between predictions from sensitivity tests and drug activity 
in clinical therapy have usually varied between 61—98%. 


Sensitivity tests on individual human tumors 
to select active drugs for clinical therapy have 
been regarded as a forward step because of their 
scientific advance 1 and accord with ethical codes 
and humanitarian values. 1 ’ 2 

Many drugs are now available for treatment 
of disseminated cancer. Many are extremely toxic 
to the patient. Use of toxic drugs inactive against 
an individual patient’s cancer may not only deny 
him the benefits of active therapy but also ac- 
celerate growth of his cancer. 3 - 4 

Routinely, therefore, we have come to use 
three sensitivity tests to rule out inactive drugs 
for each patient and to select one or more drugs 
with a good chance to be active against the 



Knock Galt Oester Sylvester 


FRANCES E. KNOCK, Ph.D., M.D., is on the surgical staff of 
Augustana and VA Hospitals, Hines; Clinical Assistant Professor 
of Surgery at the University of Illinois and Lecturer in Pharma- 
cology at Loyola University. Dr. Knock is listed in World 
Who's Who in Science as surgeon-chemist. RAYMOND M. GALT, 
M.D., is on the attending medical staff of Augustana, Cook 
County and Presbyterian-St. Luke's Hospitals, and Clinical 
Assistant Professor of Medicine at the University of Illinois, 
Chicago. Y. THOMAS OESTER, M.D., is Professor of Pharma- 
cology at Loyola University, Stritch School of Medicine and 
on the staff of the Drug Control Center, VA Hospital, Hines. 
ROBERT SYLVESTER, B.S., is a chemist. Cancer Chemotherapy 
Research Department, Drug Research at the VA Hospital, Hines, 
and Director of an independent research and development 
laboratory. 


patient’s own tumor. Agar plate assays; radio- 
active tracer studies (monitoring drug effects on 
tracer incorporation to I)NA, RNA and pro- 
tein) ; and the Kondo test, as modified in our 
laboratories, have agreed with each other in over 
85% of cases. 5 - 6 

In our laboratories and in studies throughout 
the world, all three tests can rule out inactive 
drugs with 100% accuracy. 4 ' 7 From studies at 
four university hospitals in Japan, correlations 
between sensitivity test results and clinical re- 
sults were reported as 61— 89%. 4 The group 
obtaining the poorest correlation of 61% were 
willing to study randomized patients treated with 
perfused drugs. At 9 and 18 months, survival 
rates were twice as great for patients receiving 
drugs in accord with sensitivity tests on their 
own tumors as for unselected patients. 

Transformation of normal cells by cancer-pro- 
ducing viruses now appears to require an altered 
DNA to transcribe altered information. An 
altered enzyme, DNA polymerase, may be at 
the heart of the process. Several groups of 
workers have noted the promise for rational 
cancer drug therapy of new drugs that depress 
RNA-dependent DNA polymerase activity from 
cancer producing viruses and human acute 
leukemia cells. 6 - 8 

The crucial test of the significance of sensi- 
tivity tests on human cancers, as a result, may 
be the ability of the tests to find drugs that 
depress selectively the DNA polymerase activity 
of human cancer cells and tumor viruses. The 


for August, 1974 


101 


Table 1. Effects of Drugs on In Vitro Metabolism of Normal and Cancer Cells 





Oxo IAc 

0.4 0.4 

mg/ml mg/ml 

5-FU 

0.5 

mg/ml 

Meth 

0.05 

mg/ml 

HN-2 

0.025 

mg/ml 

Premarin 

0.75 

mg/ml 

1. Normal human 


DNA 

67 

60 

40 

31 

34 

90 

leukocytes 


SDI 

26 

32 

65 

68 

56 

12 

2. Breast cancer. 


DNA 

52 

56 

86 

91 

56 

44 

domestic cat 


SDI 

46 

43 

17 

12 

44 

56 

(14 years) 









3. Breast cancer. 


DNA 

53 

55 

63 

46 

91 

53 

(Human) 


Agar 

1 

4 

5 

3 

6 

2 

(60 years) 









4. Breast cancer 


DNA 

48 

47 

71 

70 

65 

71 

(Human) 


Agar 

2 

1 

4 

5 

3 

6 

(49 years) 









5. Breast cancer 


DNA 

41 

47 

44 

85 

58 

75 

(Human) 


SDI 

57 

52 

50 

23 

49 

29 

(43 years) 


Agar 

1 

3 

2 

6 

4 

5 

6. Lung cancer, 


DNA 

59 

47 

71 

50 

41 

88 

(Human) 


SDI 

43 

46 

31 

51 

59 

18 



Agar 

4 

2 

5 

3 

1 

6 

For DNA, the numbers 

represent 

percent of control 

from 1-6. The lower the numbt 

-r, the more active the drug. 

value. The lower the 

number, the more active the drug 

Oxo-oxophenarsine(mapharsen) plus adjuncts menadiol 

against the tissue. 




(Vitamin K), malonate, fluoride and heparin 

in the ratios 

For SDI, the numbers are expressed 

as percent inhibi- 

used 

clinically ; 5 . 

lAc-iodoacetate plus adjuncts ;9 5-FU- 5- 

lion of the enzyme. 

The 

higher the 

number, the more 

fluorouracil; Meth- methotrexate; HN-2- nitrogen mustard 


active the drug. or Mechlorethamine. 

For Agar plate assay, numbers represent order of activity, 


data have recently become available. 

Materials and Methods 

Agar plate Assays: The tests resemble anti- 
biotic disc sensitivity tests. 9 Immediately after 
surgery, each patient’s living cancer cells are dis- 
sected free of necrotic cancer and normal cells, 
then minced in complete tissue culture media 
containing human serum and antibiotics. Re- 
snlts are read by midnight of the day of surgery 
and within 24 hours of surgery. End point of 
agar plate assay is activity of the many enzymes 
reacting with methylene blue. 

SDI, Succinic Dehydrogenase Inhibition, Kondo 
Test A The SDI test resembles agar plate assay 
chemically except that activity of only succinic 
dehydrogenase is monitored as end point. Drug 
activity is expressed as percent of inhibition of 
succinic dehydrogenase activity. The higher the 
value for a given drug, the more active is the 
drug against the given cancer cells. 

Radioactive Tracer Studies: The tests monitor 
drug effects on tracer incorporation to DNA, 
RNA and protein. 10 Table 1 shows drug effects 
on incorporation of tritiated thymidine to DNA, 
the most significant parameter for the particular 
drugs listed. 

Drug effects are expressed as percent of control 
values. I he lower the value, the more active 
the given drug against the cancer cells (the exact 


opposite of the Kondo test or SDI test above) . 
Reduction of tracer incorporation to less than 
60% of control is usually needed for clinical 
activity, and preferably less than 55 or 50% 
of control. 

As in all the sensitivity tests used, drug concen- 
trations vary directly with clinically permissible 
dose levels. Very toxic drugs are tested at low 
concentrations relative to less toxic drugs. 5 - 9 - 10 

Inhibition of DNA Polymerase Activity of 
Intact Cells. A double isotope technique is used 
to measure inhibition of DNA polymerase ac- 
tivity in intact cancer and normal cells. Control, 
untreated cells are incubated with a metabolic 
precursor of DNA (thymidine labelled with tri- 
tium or 3 H) and treated cells with a drug and 
the same metabolic precursor of DNA labelled 
differently (thymidine labelled with radioactive 
carbon or 14 C) . Control and treated cells are 
pooled after incubation so both suffer identical 
losses. DNA and its precursors are separated by 
chromatography. 10 

The ratios of 14 C to 3 H are determined in a 
Packard 3375 liquid scintillation spectrometer. 
Drug inhibition of DNA polymerase activity is 
seen as a large depression in the ratio to less 
than 100% of control for DNA, with a large 
increase in the ratio for thymidine triphosphate, 
the precursor of DNA. 10 

In this test, drugs are used at 1 raM concen- 
tration except for the adjuncts used with drugs 


102 


Illinois Medical Journal 


termed SH inhibitors, which react with sulfhy- 
dryl groups of proteins. Oxophenarsine, an 
arsenical previously used successfully for syphilis, 
was the first such SH inhibitor available for 
clinical use. Adjuncts menadiol, malonate, fluo- 
ride and heparin are used clinically 5 and in the 
tests to extend effects of the drug and minimize 
use of the active component. Sensitivity tests 
and animal studies showed that the adjuncts 
alone show insignificant effects against tumors 
but do significantly potentiate effects of active 
SH inhibitors, oxophenarsine and iodoacetate 
described in columns 1 and 2 of Table 1. 

Results 

Agar plate assay, the SDI test, and radioactive 
tracer studies have agreed with each other in 
over 85% of cases to date, to indicate active 
and inactive drugs for clinical therapy. 5 Agar 
plate assay gives only qualitative orders of ac- 
tivity, while the other two give quantitative data. 
Because the radioactive tracer studies also give 
clues on mechanisms of activity, they are be- 
coming increasingly important. 

All three tests can, however, rule out with 
complete accuracy drugs inactive for clinical 
therapy. This has been true in our laboratories 
and many others throughout the world. 3-10 

Table 1 shows the effects of a variety of anti- 
tumor agents on incorporation of tracers to DNA 
of normal and cancer cells, the most significant 
parameter for the drugs listed. Where available, 
data from the SDI test and agar plate assay are 
given side by side. 

Typically, one or more of the clinically useful 
SH inhibitors (oxophenarsine and iodoacetate) 
has depressed tracer incorporation to DNA of 
human and animal cancer cells more than for 
normal cells, such as liver, leukocytes (shown 
in Table 1) and wound tissues. Commonly used 
antimetabolites like 5-FU and methotrexate, and 
alkylating agents like HN-2, by contrast, have 
usually shown the reverse undesirable effects: 
greater activity against normal tissues than can- 
cer. For cancers, a low figure below 50-60% is 
desirable for DNA and a high figure, above 
50-60%, in the SDI test; with the reverse for 
normal tissues. 

Although one or more of the new or old 
clinically promising SH inhibitors has to date 
inhibited cancers more than normal, the data 
cannot be extrapolated to signify that every 
SH inhibitor is active against every tumor, or 
more active than against normal tissues. This 
is the reason for running sensitivity tests on 


each patient’s own cancer, to rule out inactive 
drugs of all types, and select from among those 
showing activity. 

The effects are illustrated in Table 1. Thus, 
for Patient 6, iodoacetate plus adjuncts was 
much more active than oxophenarsine plus ad- 
juncts, whereas the reverse is true for Patient 5, 
for example. Patient 6 obtained his clinical 
regression of lung cancer metastatic to neck nodes 
from chemotherapy with iodoacetate plus ad- 
juncts. Nitrogen mustard and methotrexate, both 
active against his tumor, were far too toxic for 
use in this debilitated patient. 

Patient 5 with massive cancer replacing liver, 
obtained her first regression from chemotherapy 
with oxophenarsine plus adjuncts. Although 
5-FU was active for this patient’s cancer, mainte- 
nance therapy with 5-FU failed because of toxi- 
city to bone marrow (illustrated in part by 
marked depression of tracer incorporation to 
human leukocytes, as seen in Table 1). Her 
second clinical regression was obtained with a 
second course of oxophenarsine, then maintained 
for over a year on iodoacetate plus adjuncts with 
occasional small doses of 5-FU (about 500 mg/ 
month). 

Just as the sensitivity tests have agreed well 
with data on both active and inactive drugs for 
mouse tumors, 1 ’ 5 ' 6 9 ’ 10 they can provide interest- 
ing correlations for higher animals. The cat listed 
in Table 2 was 10 years post menopausal. Against 
her cancer, Premarin® was the most active drug 
found, as would be expected for a human patient 
very many years post menopausal. Eight months 
after initiation of therapy with Premarin,® the 
cat is clinically free of evidence of cancer, despite 
the fact that her cancer was unusually aggressive, 
having about tripled in size in less than a month. 
By contrast, for the human cancer patients with 
breast cancer listed in Table 1, Premarin® was 
found to be less active the younger the patient. 

Only for the 60-year-old Patient 3, ten years 
post menopausal at the time of radical mastec- 
tomy, has any Premarin® been used clinically. 
Postoperatively, the patient received a course of 
oxophenarsine plus adjuncts, then has been 
maintained on iodoacetate plus adjuncts and 
estrogen. The patient is indeterminate for effects 
of any one drug. Four years postoperatively, 
her liver scan, originally interpreted as consistent 
with multiple small metastases, was diagnosed 
as showing no evidence of disease. 

The 49-year-old Patient 4 was admitted with 
widespread breast cancer, including metastases 
to face and scalp. She obtained her first regres- 


for August, 1974 


103 


sion of all scalp metastases on oxophenarsine 
plus adjuncts. Thereafter, she was maintained 
for over one and a half years on iodoacetate 
plus adjuncts along with halotestin. A brittle 
diabetic, she suffered a fatal heart attack during 
the night following a day of heavy physical 
activity. 

Just as the SH inhibitors show relatively little 
effect against leukocytes, they have shown little 
effect against normal liver and normal healing 
wounds. 5 - 10 Clinically they have shown no ill 
effects on wound healing and peripheral blood 
counts by contrast with commonly used anti- 
metabolites and alkylating agents which often 
must be withheld for four to six weeks post- 
operatively and frequently depress peripheral 
counts markedly. Clinically, regressions have 
been obtained in the majority of patients treated 
with the SH inhibitors, where objective effects 
of chemotherapy could be measured. 5 ’ 9 

Table 2 illustrates a possible reason for the 
apparently preferential effects seen clinically on 
some human cancers with the clinically useful 
SH inhibitors. Here, effects of promising rifamy- 
cin antibiotics and SH inhibitors are seen on 
intact cancer cells from the 43-year-old patient 
suffering from breast cancer, listed as Patient 5 
in Table 1. The clinically promising SH inhibi- 
tors (including oxophenarsine on which the 
patient obtained her clinical regression) mark- 
edly inhibit DNA polymerase activity, as seen 
from accumulation of label in thymidine triphos- 
phate and depression of label in DNA relative 
to controls, but with much less effect on normal 
leukocytes. 


Table 2. Effects of Drugs on DNA Polymerase Ac- 
tivity of Intact Normal and Cancer Cells 


Tissue 

Average Value of ;3f{ Ratio as % 

Thymidine 

Drugs Triphosphate 

of Control 
DNA 

Normal 

Oxo 

156 

65 

Human 

IAc 

160 

56 

Leukocytes 

IIN-2 

156 

25 


Cytosar 

216 

20 


N-Deniethyl- 

rifampicin 

162 

42 


N-Demethyl-N 

Benzyl Rifampicin 

174 

30 

Human 

Oxo 

210 

19 

Breast 

IAc 

204 

17 

Cancer 

(Patient 

aged 

5-FU 

124 

131 

43 years) 

N-Demethyl- 

rifampicin 

139 

49 


N-Demethyl-N 

Benzyl Rifampicin 

83 

72 


Abbreviations are the same as those used in Table 1. 
The greater the inhibition of DNA polymerase activity, 
the lower is the ratio for DNA, and the higher the ratio 
for the immediate precursor of DNA, thymidine triphos- 
phate. 


The rifamycin antibiotics which have received 
considerable attention for their ability to depress 
DNA polymerase activity of oncogenic viruses 
and human acute leukemic lymphoblasts, by 
contrast, show much less effect against the intact 
cancer cells than against normal leukocytes, as 
has been found with other cancers and normal 
tissues. 

Previously published data have shown that 
the clinically useful SH inhibitors are also ex- 
tremely active against DNA polymerase activity 
from oncogenic virus and human leukemia cells, 
with activity usually far exceeding that of avail- 
able rifamycins. 10 

Discussion 

Clinically, the use of sensitivity tests on in- 
dividual human cancers was started to match 
cancer chemotherapy with the highly variable 
requirements seen clinically among patients with 
cancers of the same histology. Many groups have 
now confirmed the ability of the sensitivity tests 
to ride out inactive drugs with complete ac- 
curacy. 4-9 

For workers who vary drug concentrations 
in the tests in accord with clinically permissible 
dose levels, overall accuracy of the tests for solid 
tumors has ranged from 61% to as high as 
98%. 11 The value of the tests has been seen 
not only in rates of regression but in survival 
rates in randomized studies as well. 4-9 ’ u 

Because transformation of normal cells by 
oncogenic viruses now appears to require altered 
DNA polymerase activity to transcribe altered 
genetic information, the ability of the sensitivity 
tests to select antitumor agents inhibiting DNA 
polymerase activity of cancer cells might be 
regarded as a crucial test of the value of the 
sensitivity testing. 

As early as 1967, the sensitivity tests had 
shown preferential effects of selected SH inhibi- 
tors against enough human cancers so that action 
of the drugs on DNA polymerase activity of 
cancer cells was anticipated. 6 A deliberate search 
for the reason for the apparently preferential 
effect seen by selected SH inhibitors against 
some human cancers showed that the drugs 
inhibited markedly DNA polymerase activity 
from oncogenic virus, from human acute leu- 
kemia cells 10 and from a variety of intact human 
cancer cells, as well. Multiple workers have now 
noted the promise for rational chemotherapy of 
drugs inhibiting DNA polymerase activity from 
oncogenic viruses and leukemia cells. 8 

As a result, the value of sensitivity testing for 
cancer therapy and cancer research would appear 
to be adequately confirmed. ◄ 

References 

A complete bibliography may be obtained by writing 
the Illinois Medical Journal, 300 N. Michigan Ave., Chi- 
cago, 60601. 


104 


Illinois Medical Journal 


Deafness and Acupuncture 

By Max S. Sadove, M.D., Koji Okazaki, O.M.D., Sang Ik Kim, M.D., 
Man H. Lee, O.M.D., Tak Ho Liu, M.D., O.M.D. /Chicago 


With the reopening of communications with 
China, the Western world heard of the treatment 
of deafness— even nerve deafness by acupuncture. 
In movies we saw formerly deaf children sing, 
dance and play musical instruments. But from 
that day to this, there have been no significant 
statistics. There have been no data as to standards 
of selection; standards of improvement; per- 
centage of improvement; etc.; nothing but the 
statements and movies that there was improve- 
ment; no evidence of a series of control audio- 
grams over a period of time and/or changes pro- 
duced by therapy in a large enough number of 
cases to draw a scientific conclusion. 

Thus, all reactions were and are totally emo- 
tional. Some physicians were totally agnostic; 
some had complete, total, and irrevocable dis- 
belief; others, the majority, were totally confused. 
Most physicians could not even guess how to 
answer the patient inquiries— “Should I try it or 
not?”; “What are the chances of it helping and 
harming?” In general, most agree there is rela- 
tively little chance of harm. But what of chance 
of improvement— this was not known and is not 
known now. 

Approximately a year ago, a grandmother 
called and asked if we would not please treat her 
grandchild for nerve deafness. We told her we 
could not without referral and without a con- 
sultation by an otologist— and also we doubted 
that the chances of success were more than 1 to 
2500 in our opinion. The answer was somewhat 
startling— “Make it 1 in 5000 and can we come 
next week after seeing our other doctor? After 
all, no one else has anything to offer.” This cry 
has been heard over and over and it must be 
answered soon. 

It is obvious to us all that the chances of 
charlatanism are astronomical. Also, the chances 
of harm are not negligible if competent otologists 

MAX S. SADOVE, M.D., is Professor and Chairman of the 
Department of Anesthesiology, Rush Presbyterian-St. Luke's Hos- 
pital, Rush Medical College and Physician Coordinator of the 
Rush Pain Center, Chicago. SANG IK KIM, M.D., is Assistant 
Professor in the Department of Anesthesiology at Rush Medical 
College and Assistant Physician Coordinator of the Rush Pain 
Center. KOJI OKAZAKI, O.M.D. , MAN H. LEE, O.M.D. , and 
TAK HO LIU, M.D., O.M.D., are acupuncturists at the Rush Pain 
Center. 


do not follow these patients. The waste of time 
and money may also frequently be very signifi- 
cant. In addition, false hope has its psychic harm 
and that can be markedly injurious. Yet, the 
question can acupuncture help any form of deaf- 
ness must be answered. Some have papers in the 
professional press reporting a negative case. 
Others have stated after following a handful of 
cases, that acupuncture is a hoax. Still others have 
reported changes in less than a handful of cases 
and made a statistical conclusion. Also, will the 
usual “acupuncture clinic” know when to look 
for a cerebellopontine angle tumor? Will anti- 
biotics be discontinued that are being chronically 
used on the patient and may be contributing or 
actually causing the deafness? Will the patient be 
removed from vapors or fumes of toxic agents 
such as the degreasing agents, cleaning agents, 
paints, etc., that can be a factor? In most in- 
stances these factors will not even be considered 
by a non-physician group. Is there anything to 
suggest that the deafness is on a vascular basis 
(either small or large vessel) that could respond 
to more logical therapy? 

Dr. Fredrik F. Kao and his co-workers from 
State University of Downstate Medical Center, 
New York, have reported in the American Jour- 
nal of Chinese Medicine as of July, 1973, the 
improvement in five patients. This study shows 
control audiograms and a battery of other tests 
as well as post therapy audiograms and tests. The 
evidence of improvement is amazing. This group 
is highly competent, scientific and current as to 
the recent changes that are occurring with acu- 
puncture in China. This study forces scientific 
groups to carefully evaluate their techniques and 
the minutia associated with their routine. They 
also force logical investigators to reevaluate their 
therapy and continue to investigate acupuncture 
as a mode of therapy for deafness. 

Activities of the Pain Clinic 

Approximately two years ago, we decided that 
acupuncture should be studied for its usefulness 
in management of pain. This we concluded be- 
cause a dear friend, Professor M. Hyodo, Medical 
College of Kyoto, found acupuncture useful in 
his pain clinic. Approximately one third of all 


jor August, 1974 


105 


the referred pain problems were treated with 
acupuncture in his clinic even though this group 
had available all the common drugs of Japan; 
also, they were extremely competent in the use of 
all the common regional techniques. Dr. Hyodo 
was invited to Rush-Presbyterian-St. Luke’s Med- 
ical Center. Our plans were submitted to our 
peer groups and approved. Being skeptical at the 
time as to its value to the patients, no charges 
were made for therapy. The staff was notified of 
onr activities and immediately an excess of pa- 
tients was available. After three months of ac- 
tivity, the study was stopped and our activity 
evaluated. There was an inescapable conclusion 
—acupuncture served a useful place in the man- 
agement of pain problems and also studies were 
justified in many other disease syndromes. 

Additional space was obtained, additional per- 
sonnel added and a center organized that con- 
sisted of a minimum of two doctors of Oriental 
Medicine and two M.D.’s in addition to varying 
numbers of residents, interns and visiting phy- 
sicians. All patients were and are referred by 
physicians. A consultant group was formed and 
organized and provision was made for hospi- 
talization of those requiring that action. Ap- 
proximately 600 to 700 patients per month have 
been treated by a team of five people. A mini- 
mum of two physicians and also a director is 
available at a moments notice, being the basic 
unit. 

It was annoying not to be able to answer the 
question as to the effect of acupuncture on deaf- 
ness. In the initial group, we simply refused to 
try this technique, but in early months of study, 
we noticed that tinnitus and vertigo were fre- 
quently improved in patients with headaches and 
menieres disease and in patients where tinnitus 
was a primary complaint. 

We concluded that if acupuncture clinically 
improved patients suffering from tinnitus and 
vertigo, it might help deafness. Requests wer6 
being made for therapy for deafness. We attempt- 
ed to have all patients seen in our own ear ser- 
vice but some came with complete work-ups 
including recent audiograms, and it was oc- 
casionally not repeated but follow-ups were 
strongly encouraged. 

Results 

Thirty patients have been treated, none have 
shown a definite (10% or more) increase in the 
audiogram. More than one third of the patients 
have an impression that their audiotory dis- 
crimination was better. Such things as a hearing 
aid seemed to work better, as do phone amplifiers 
or the phone itself, or television. Noises, either 


internal or external, are diminished in approxi- 
mately 25% of those who have this symptom. 
Curiously almost all of these patients state that 
the noise is at a lower pitch and shorter duration 
or as they describe it, the noise is milder. This 
number is too small to justify a statistical type 
conclusion or even a clinical conclusion. 

Discussion 

We have concluded that a technique that is 
less than maximal is not justified at this time. We 
are forced to conclude that the old classical treat- 
ment as well as some of the more recent therapy 
must be extended in its duration. This technique 
of increasing the duration of effect is becoming- 
more frequent in China. The peripheral points' 
are being used less frequently and a routine such 
as chromic catgut is being placed intradermally 
at the newer acupuncture points or the intra- 
dermal needles may be used in place of the su- 
ture. This would diminish overall cost in that 
the patient would be treated less frequently. 
These patients must be carefully evaluated prior 
to therapy also a careful and complete battery of 
tests must be included. The pattern of evaluation 
of Dr. F. F. Kao, et. al., seems to be an excellent 
one. 

However, this study might be more easily per- 
formed in a school or several schools for the deaf. 
Thus, this could be done to a significant number 
of people by this approach in a relatively short 
time and controls could be carried out relatively 
easily. By training of local nurses in this one 
technique, the cost can be kept to a reasonable 
level. A panel of experts, primarily otologists, in- 
cluding statisticians, public health experts, etc., 
should help plan and evaluate results. 

Simply accumulating a small series in a few 
places in the nation will not stop the hope, true 
or false, nor will it stop the exploitation or 
dabbling. The true scientist has little choice but 
to search for the truth. 

Conclusion 

At present, after almost two years of limited 
activity in acupuncture therapy for deafness by 
the classical technique, we can make no state- 
ment but that we have failed in our initial ac- 
tivity to significantly improve patients. However, 
we are not satisfied and we can not stop. We 
must study the new and more intensive tech- 
niques in all fairness to reach a correct conclu- 
sion. We sincerely believe that this must be 
studied in an adequate number of patients, pref- 
erably in a number of our state institutions or 
by a state or philanthropically sponsored study 
group. ^ 


106 


Illinois Medical Journal 


Improving Medical Service in Long Term Care Facilities 

By Bertram B. Moss,, M.D., Chicago; and Michael A. Werckle, M.D./Springfield 


A skilled nursing home must have a medical 
director either on a full-time or consultant basis 
and an intermediate care facility must have a 
physician provide continuing supervision, see 
residents as needed, and in no case less than 
quarterly, unless justified otherwise and docu- 
mented by the attending physician. 

A medical director’s hrst responsibility is to pa- 
tient care, and he should not be encumbered 
with too many “administrative” duties. He 
should oversee any aspect of the nursing home 
operation that has a potential effect on patient 
health, such as dietary service, housekeeping and 
maintenance. A medical director must define his 
duties to his own assessment of the circumstances 
prevailing in a given facility and should not be 
held to a rigid job description. 

The AMA’s Committee on Aging has drafted 
a preliminary statement on the medical director’s 
role. It said, “a medical director should be re- 
tained by a facility’s governing body, with the 
approval of the organized medical staff if one 
should exist. The amount of time spent carrying 
out the specified duties of a medical director 
should be independent of the time spent provid- 
ing direct patient care. The compensation for the 
medical director should not be in the form of 
patient referral or consultation.” 

The AMA committee suggested that a medical 
director should: 

1. Assist in arranging for continuous physician 
coverage for medical emergencies and in de- 
veloping procedures for emergency treatment 
of patients. 

2. Participate in development of a system pro- 
viding a medical care plan for each patient, 
which covers medications, nursing care, re- 
storative services, diet, and other services, and, 
if appropriate, a plan for discharge. 

3. Be the medical representative of the facility 
in the community. 

4. Develop liaison with attending staff physicians 
in efforts to ensure effective medical care. 

5. In the absence of an organized medical staff, be 
responsible for the development of written by- 
laws, rules and regulations applicable to each 
physician attending patients in the facility. 

BERTRAM B. MOSS, M.D., is Chief, Geriatrics Program Devel- 
opment, Illinois Department of Public Health, Office of Health 
Facilities and Quality of Care. At the time of writing, Dr. Moss 
was Executive Director, Park View Home, Chicago, M. A. 
WERCKLE, M.D., is Associate Director, Illinois Department of 
Public Health. 


6. If there is an organized medical staff, be a 
member, attend meetings and help assure ad- 
herence to medical staff bylaws, rules and 
regulations. 

7. Participate in developing written policies gov- 
erning the medical, nursing, and related health 
services provided in the facility. 

8. Participate in developing patient admission 
and discharge policies. 

9. Participate in an effective program of long- 
term care review. 

10. Be available for consultation in the develop- 
ment and maintenance of an adequate medical 
record system. 

1 1 . Advise the administrator as to the adequacy 
of the facility’s patient care services and med- 
ical equipment. ' 

12. Be available for consultation with the ad- 
ministrator and the director of nursing in 
evaluating the adequacy of the nursing staff 
and the facility to meet the psychosocial as 
well as the medical and physical needs of 
patients. 

13. Be available for consultation and participa- 
tion in in-service training programs. 

14. Advise the administration on employee health 
policies. 

15. Be knowledgeable concerning policies and 
programs of public health agencies which may 
affect patient care programs in the facility. 

Doctors comprise 3% of all employees of long- 
term care facilities. Today, the number of facili- 
ties has grown, but the proportion of medical 
house-staff remains relatively small. Doctors must 
be encouraged to serve patients in long-term 
care facilities. 

It is a general feeling that doctors will not 
become medical directors in large numbers until 
appropriate reimbursement makes the rewards 
of such positions competitive with private prac- 
tice. If the nursing home hires a physician or 
finds some means of carrying out the required 
functions of a medical director, then those be- 
come allowable expenses of the nursing home, 
and should therefore become part of the reinr- 
burseable rate. 

Discrepancy between the amount of reimburse- 
ment, and the salary necessary to attract medical 
directors on a large scale, might encourage some 
nursing homes to continue to operate without 
medical directors. The services of a medical di- 
rector could be secured by the home if the 
AMA’s tentative prohibition against compensa- 
tion in the form of patient referrals and the Illi- 
nois Department of Public Aid restriction against 
supplemental care are both compromised. The 
problem of compensation is more serious for 


for August , 1974 


107 


nursing homes with fewer than 200 beds. Larger 
institutions appear more inclined to afford full- 
time medical directors. 

Physicians may eventually be ethically per- 
mitted to join together with a nursing home and 
accept on a per capita basis, a payment for the 
total care of all assigned public aid recipients. 
Basically, the proposal is for physicians under a 
single supplemental payment plan to provide 
total medical care to an assigned patient from 
moment of admission to discharge, transfer or 
demise. 

A medical group could serve the patients in 
several long-term care facilities and create a medi- 
cal staff equivalent that would serve several 
nursing homes in the community. The medical 
group and the nursing homes could cooperate to 
establish: 

1. an executive committee composed 
of physicians and administrators; 

2. a medical audit committee con- 
sisting only of physicians; 

3. a procedural review committee 
composed of administrators and 
physicians and directed by a phy- 
sician; and 

4. a utilization review committee of 
physicians, and other professionals. 

This alliance would increase the interest, com- 
munication and active participation of com- 
munity physicians in the affairs of long-term care 
facilities, and result in improved quality of medi- 
cal and nursing care. Quantity of care must 
never be substituted for quality. Quality care 
implies its application at the right time and in 
proper quantity. 

Skilled and intermediate care facilities should 
be encouraged to provide parallel or alternative 
community-oriented services such as home health 
and geriatric day care. The adoption of H.R.l 
is almost as important as the inception of Medi- 
care, and will drastically increase the significance 
of nursing home medical directors. Physicians in 
long-term care facilities must be prepared to be 
knowledgeable and make full use of the parallel 
services and alternatives to institutional care. 

The short-range objective of the AMA pro- 
posed program is to prepare physicians to serve 
as medical directors in intermediate and skilled 
homes, and to upgrade the skills and knowledge 
of those who now serve in such posts. The long- 
range goal is to establish permanent state medical 
society committees on Aging to have continuing 
responsibility for supplying and upgrading medi- 
cal services in the homes. This will result in an 


increased supply of physicians willing and cap- 
able of serving nursing homes as medical di- 
rectors. 

Physician Services Arrangements 

There are four basic types of arrangements for 
Physician Services in nursing homes: 

1. Employment of a full-time on-call 
physician, with a designated al- 
ternate. 

2. Arrangement for a physician to 
come to the home at regular and 
periodic intervals. 

3. Arrangement for a physician to 
come to the home when needed 
but not at regular intervals. 

4. Arrangement for a physician to 
give medical care to the residents 
of the home in his own office. 

The majority (54%) of all the nursing homes 
serving residents in 1968 arranged to have a 
physician come to the home when he was needed 
but not at regular intervals, with 34% having a 
physician to visit the home at regular intervals; 
7% employed a full-time physician, 2% arranged 
for office visits, and the remaining 3% made no 
arrangements for physician services. 

Virtually all of the homes arranged for physi- 
cian services, hut most of the arrangements dealt 
with treating the patient after he became ill. 
Only those homes which had a full-time staff 
physician visit regularly (34%) offered the chance 
of preventing an illness from occurring; 47% 
of the homes with over 100 beds arranged for a 
physician to visit the home regularly; and 15% 
employed a full-time physician to come when 
needed. 

Preventive Medicine 

Responsible medical directors should help al- 
leviate some of the major medical problems of 
long-term care facilities if they will practice 
preventive medicine. The cost of preventing ill- 
ness (or its complication) should be as reim- 
bursable as the cost of treatment of existing 
illness. The moral and economic incentive must 
be to keep patients well, rather than to only 
treat the sick. Control will be assured by having 
a responsible medical director. Nursing home 
staffs must not operate only with a reimburse- 
ment motive. Sick residents of homes should not 
be capitalized on and viewed as potential dollars 
rather than sick human beings. We need clear 


108 


Illinois Medical Journal 


policy with regard to the infirm or confused 
elderly with quality care and their individual 
needs being assigned the highest priority. 

We urgently need more properly trained per- 
sonnel as well as more physician participation 
with definite responsibility in long-term care fa- 
cilities. A reimbursement system is needed which 
provides a fair rate of return for the well in- 
tended operators and physicians to provide good 
environmental social and preventive medical 
care. Regulatory agencies must accredit institu- 
tions not solely on the basis of physical require- 
ments but on demonstrated quality of patient 
care. Long-term care facilities will be thought of 
as a last recourse and not the easy solution for 
elderly persons troubled by less than perfect 
health or some unmet social need, as soon as al- 
ternative and parallel services are available. 

Far reaching efforts have been made in the last 
few years to break down the difference between 
“service” (ward) patients and private patients. 
In many instances this has included equal phys- 
ical facilities for all patients. Large wards have 
been renovated into two and four bed units and 
in new construction no units larger than four-bed 
will be built. Staff should not be able to distin- 
guish between private and non-private pay resi- 
dents and must give equal care and service to all 
as evidenced by frequent chart notes, and contact 
with the patient and his family. 

We need some form of insurance, similar to 
what we have for hospitalization, for those who 
require nursing home care. In Illinois, there are 
currently less than 30% private-pay residents in 
long-term care nursing facilities. The remaining 
70% are subsidized by State public aid. We must 
settle for nothing less than one class of quality 
care for our elderly who have outlived their 
money or their families. Many of them are vic- 
tims of inadequate retirement or pension plans, 
and most of them are victims of our inflation. 

The most critical unsolved health problems 
that confront all of us entail social and environ- 
ment factors that are totally avoided or neglected. 
These include preventive health methods, mental 
disorders, behavioral aspects of health mainte- 
nance, geriatric and other chronic illnesses, diffi- 
culties in access to health care, and the effects of 
poverty on health. We are specifically concerned 
about the elderly who are incapable of helping 
themselves. The greatest percentage of impover- 
ished old and often confused persons still live in 
the general community. Of the approximately 
5% who are institutionalized in Illinois, about 
70% receive public financial aid. The number of 


elderly persons and their life span will increase, 
and their needs will also increase. 

A major mistake has been the assumption that 
the responsibilities of health care professionals 
began and ended with biologic research and its 
application to individual patients. The social 
problems relative to health care are chief of those 
yet unsolved. Our academic health centers have 
yet to establish any over-all health research poli- 
cy, to evaluate adequately the benefits and costs 
of clinical procedures, and to take an active in- 
terest in patient-care or research for the aged. 
Another major error is the insistence by regula- 
tory agencies of detailed written documentation 
of the delivery of care and service. This can only 
he accomplished by the very few available pro- 
fessionals already over burdened with direct pa- 
tient care and service. Surveyors should be so- 
phisticated enough to be able to evaluate the 
quality of care and service actually performed, 
and free professionals from the required docu- 
mentation. Until we develop enough trained and 
experienced professionals to care for patients in 
long-term care facilities, we must be content with 
proper care and service rather than written docu- 
mentation. 

Ten percent of our population is above 65 
years of age, and the percentage is increasing. We 
cannot solve their problems without the help of 
experts in many other nonmedical fields. New 
kinds of people must be immediately recruited 
and trained, and new community and institu- 
tional arrangements made. Priorities must be es- 
tablished to recognize the needs of the elderly as 
primarily financial; secondarily, the inability to 
cope with psycho-social components of life; and 
then the unavialibility of the skills of geriatric- 
health-care professionals to care for their needs. 

Need For Autonomous State Department 

Each State must have its own autonomous de- 
partment concerned with providing care and ser- 
vices to the elderly. Staff of this department must 
be knowledgeable about old persons, their needs, 
and how to provide what is the best available for 
them in the community and in institutions. 

The main thrust of care for the elderly by the 
government must be directed toward: 

1 . a greater emphasis on continuous 
accessible outpatient community 
prevention care and treatment; and 

2. A more efficient operation and 
utilization of health facilities. 


for August , 1974 


109 


The minimum standards requiring physician 
visits to residents for long-term care facilities and 
the fees paid for these visits is totally inadequate. 
The motivation of government in setting such 
inadequate standards for physician visits was 
based on concepts to avoid over-utilization of 
medical services. Rather than over-utilization of 
medical services by patients in long-term care 
facilities, a computer survey in Illinois in 1972, 
showed that only 70% of physicians were in com- 
pliance with the rules on visits and medication 
reviews. Another 15% were shown as having 
“minor” irregularities, and another 15% were 
“significantly” deficient. Physicians who accept 
patients needing long-term care, and then fail to 
provide it, are a main cause of poor care and 
possible nursing home licensure revocation. 
Twenty percent of the violations of promulgated 
minimum standards of long-term care facilities 
were due primarily to non-compliance of medi- 
cation review by physicians. 

It is the prime responsibility of the attending 
physician to determine the need for physician 
visits for each resident. This need must also be 
a committment shared by families and residents 
of long-term care facilities as well as by the De- 
partment of Public Aid which pays for needed 
medical services. 

Immediate action is required to provide the 
quantity and quality of nursing home care that 
will prevent deficiencies in nursing home profes- 
sional attendance and inadequate review of medi- 
cations. State Medical Societies should have their 
Committees on Aging take immediate appropri- 
ate action to insure that: 

1. Every licensed nursing home pa- 
tient has an active attending physi- 
cian, who acknowledges his con- 
tinuing responsibility in writing: 

2. Every such attending physician as- 
sumes adequate responsibility for 
finding and designating an alter- 
nate in the event he cannot fulfill 
this professional obligation; 

3. In the event attending physicians 
fail to properly exercise either of 
their responsibilities, medical di- 
rectors and licensed nursing home 
administrators take prompt and 
appropriate action through local 
societies to obtain active attending 
physicians: 

4. All physicians, patients and re- 
sponsible family plus responsible 


state agencies are fully informed 
regarding these requirements and 
are fully consulted prior to under- 
taking any of the foregoing ar- 
rangement; 

5. All interested parties are promptly 
informed regarding the identity of 
attending physician’s status; and 

6. Local medical societies accept full 
responsibility for enforcing all of 
the foregoing through peer review 
and other appropriate committee 
activity. 

It does not necessarily follow that if physicians 
do become part of an employed profession, they 
will lose much of their control in medical policy- 
making. 

Physicians do not always need non-medical ad- 
ministrators to manage the business end of their 
profession and to determine how medical care 
can best be delivered. Help in the delivery of 
medical care can come from non-physicians. 
Properly used, their services may lessen the load 
on the physician’s time. Administrators must see 
their roles as supporters of the physician and 
should not take over and administer medical 
programs. 

Summary 

The nursing home must not profit by render- 
ing poor warehousing care instead of quality 
socio-medical nursing care. No one should be 
subjected to long-term care institutionalization if 
there is a proper alternative. Society must com- 
mit itself to a definite policy with regard to the 
care and treatment of our infirm and elderly 
before any profession can profess their own 
policy. Adequately trained and experienced pro- 
fessionals must become a realistic fact in caring 
for the aged before we can state that true pro- 
fessionals can deliver or supervise the care in 
nursing homes. No profession should permit its 
disciples to neglect, abandon, tolerate inadequate 
or improper care or poor supervision, of old peo- 
ple in long-term care facilities. The final respon- 
sibility must be shared by all the licensed pro- 
fessional personnel in the homes. We must correct 
our cultural myths and misconceptions about the 
elderly and find cures for the social and physical, 
illnesses of old age. We must understand the 
aging process. Perhaps we can then prevent the 
ego-damaging anxiety, depression and other ad- 
verse physical and emotional responses all too 
prevalent among the aging population. ◄ 


110 


Illinois Medical Journal 


Pediatric Perplexities 


Ruth Andrea Seeler, M.D . , Editor 


Meandering Catheter 

By Vivian J. Harris, M.D., Director 

Department of Pediatric Radiology, Cook County Childrens Hospital and 
Hektoen Institute For Medical Research 


Indwelling catheterization of the umbilical ar- 
tery or vein is frequently a necessary procedure 
in the newborn infant with respiratory distress in 
order to monitor the ventilatory and metabolic 
status. Umbilical catheters can also be used for 
infusions, transfusions and cultures. Although 
not without some risk to the patient, this is 
largerly responsible for current improvement in 
neonatal care. 

Proper localization may be estimated by clini- 
cal methods but is best determined by roentgeno- 
grams of abdomen. 1 " 4 With use of such roent- 
genograms the catheter can be placed in the 
safest location; in external iliac artery for um- 
bilical artery catheters, just below diaphragmatic 
leaflet for venous catheters. In the latter instance 
the catheter will be in the ductus venous-inferior 
vena cava segment. 1 ’ 3 ’ 5 

Anatomy 

The umbilical vein ascends from the umbilicus 
in the free edge of the falciform ligament towards 
the porta hepatis when it enters the left portal 
vein (Figure 1). Several branches are given off 
to the quadrate and left lobes of the liver; the 
course of the vein is extrahepatic. The ductus 
venosus is a branchless shunt which arises op- 
posite to the umbilical vein outlet, and passes 
along visceral surface of the liver, empties into 
the left or middle hepatic vein, very close to their 
entry into the inferior vena cava. 

The umbilical arteries pass inferiorly on the 
side of bladder, cross the distal ureters and then 
turn superiorly to join internal iliac arteries. 
These ascend to the common iliac which go 
medially and superiorly to abdominal aorta. 

Case Reports 

Catheters especially those used for infusions, 
inadvertently left in undesirable locations, can 



Figure 1. Umbilical artery and vein in the newborn. 
Catheters are shown in ideal locations. 


contribute to life-threatening situations for the 
patient. Incorrect placements are common and 
easily re-positioned when recognized. Represen- 
tative example of problems encountered with 
poor catheter positions are briefly presented. 
Case 1: This premature female was born after 
34 weeks gestation with a birth weight of 3 lbs. 
14 ozs., and had an apgar score of 4. She had 
many malformations including flexion deformi- 
ties of the wrists and fingers of both hands, in- 
ternal rotation of the feet, kyphoscoliosis of the 
spine and an easily palpable horseshoe kidney. 
An umbilical venous catheter left in the liver for 


for August, 1974 


111 



Figure 2. An umbilical venous catheter utilized for 
an intravenous pyelogram. On the first roentgeno- 
gram after the injection of contrast there is opacifi- 
cation of hepatic lobules. 



Figure 3. An umbilical venous catheter has been in- 
troduced into the heart and lies transversely crossing 
the tricuspid valve twice. 

infusion was utilized for an intravenous pyelo- 
gram. Initial film showed massive opacification 
of hepatic radicles (Figure 2) . Subsequent films 



Figure 4. An umbilical artery catheter is in place 
with its tip at the level of T 12 . There is evidence of 
free air in the peritoneal cavity with air surrounding 
the liver, separating the bowel loops and outlining the 
falciform ligament. 



Figure 5. An upright view of the same patient as in 
Figure 4 confirms the presence of free air, under 
both diaphragmatic leaflets. 


demonstrated a horseshoe kidney and strictures 
of the uretero vesical junction bilaterally. She 
developed respiratory stridor due to paralysis of 


112 


Illinois Medical Journal 



the vocal cords and required a tracheostomy. The 
infant went steadily downhill and died. An 
autopsy was performed. 

Comment ■ There is a potetnial danger of liver 
abscess when a catheter left in region of liver is 
used for infusion of hypertonic solutions. At 
autopsy, no liver abscess was present, however, 
there was infiltration of chronic inflammatory 
cells around the periportal area and acute in- 
flammatory cells replacing the liver cells. 

Cose 2 : The patient was a 3 lb. premature with 
an apgar score of 10 at birth. Within two hours 
the infant developed respiratory distress with 
grunting respirations, and gradual onset of rapid 
respiratory rate and cyanosis. An umbilical ve- 
nous catheter placed for electrolyte and blood gas 
monitoring, is seen within the heart, crossing 
the tricuspid valve and recrossing to re-enter the 
right atrium (Figure 3). l ire roentgenogram also 
confirms the clinical diagnosis of hyaline mem- 
brane disease. Despite use of 70% Oo, grunting 
spells and retractions became worse. Fleart rate 
was 170/min. with no murmurs audible. The 
infant developed bloody urine, apneic spells, 
shallow breathing and increasing cyanosis and 
died at 15 hours of age. 

Comment: If a stiff catheter is used the effect of 
this may produce tricuspid insufficiency by hold- 
ing valve open, but there is generally no valve 
damage with the polythylene catheters in use 
today. Other possible complications include 
thrombosis and perforation. 

Cose 3: This female infant was 28 weeks gesta- 
tion, weighed 2 lbs. 5 oz. at birth and had an 
apgar score of 6. She developed grunting respira- 
tions and retractions shortly after birth. Um- 
bilical artery catheterization was done on day of 
birth and used for intravenous fluids, blood gases 
and electrocytes. She did well until the 11th day 
of life when she developed apneic spells and 
lethargy. On the 12th clay the abdomen became 
distended. She had a normal small stool that day; 
bowel sounds were hypoactive. Supine and up- 
right views of the abdomen showed free air in 
peritoneal cavity and thickened bowel loop walls 
(Figures 4 & 5) . Laporatomy revealed a mesen- 
teric thrombosis necessitating resection of 50% 
of the small bowel. The infant succumbed two 
days later. At necropsy thrombosis in aorta, renal, 
superior mesenteric and left iliac arteries were 
found (Figure 6) . 

Comment: Umbilical catheters should always be 
removed as soon as possible. Despite the most 
diligent care including use of the least throm- 
bogenic material, flushing or infusion with 
heparinatecl saline and pressure monitoring there 
still remains a risk of thrombosis. Free air in the 
peritoneal cavity indicates that bowel supplied 



Figure 6. Autopsy specimen of the thrombosis in 
abdominal aorta shows extensive course. Same pa- 
tient as shown in Figs. 4 and 5. 



Figure 7. The umbilical venous catheter is seen turn- 
ing toward the left and crossing the abdomen trans- 
versely. The tip is in the lower left abdomen. 


by arteries involved has become necrotic and 
perforated. 

Cose 1: This infant was a 40 week gestational age 
female with birth weight of 5 lbs. 16 ozs. She was 
a floppy baby with odd facial appearance and 
weak cry. Ears were small, low set and peculiarly 
rotated. There was micropthalmia, enopthalmos 
( Continued on page 116 ) 


for August, 1974 


113 


Status 

Symbol 




...duodenal ulcer— 
his price for recognition 

The diagnosis of this overachiever was duodenal 
ulcer. The prognosis was excellent until the patient 
received his promotion to department manager. Then 
his efforts to prove himself by setting impossible goals 
resulted in overwork, frustration, tension and undue 
anxiety for both him and his staff. As his physician 
knows, this excessive tension and anxiety to achieve 
unrealistic goals might not be without high cost— an 
exacerbation of his duodenal ulcer. 

The patient who needs 
adjunctive therapy 
that provides dual activity 

The ulcer patient often presents a special twofold 
problem— increased gastric secretions and hypermo- 
tility plus associated undue anxiety. These two factors 
may adversely affect the healing process. This is 
where adjunctive, dual-action Librax® may often help. 

Librax- specifically 
formulated for dual action 

Only Librax provides, in a single capsule, the special 
dual activities of these components: the antianxiety 
action of Librium® (chlordiazepoxide HC1) and the 
antisecretory/antispasmodic action of Quarzan™ 
(clidinium Br). When undue anxiety contributes to 
the exacerbation of duodenal ulcer symptoms, dual- 
action Librax is often a highly useful therapeutic 
addition to the regimen. 

Up to 8 capsules daily 
in divided doses 

For optimal response, dosage should be adjusted to 
your patient’s requirements— 1 or 2 capsules, 3 or 4 
times daily. Rx: Librax #35 for initial evaluation 
of patient response to therapy. Rx: Librax #100 for 
follow-up therapy— this prescription for 2 or 3 weeks’ 
medication can help maintain patient gains. 


Before prescribing, please consult complete product informa- 
tion, a summary of which follows: 

Indications: Symptomatic relief of hypersecretion, hypermo- 
tility and anxiety and tension states associated with organic 
or functional gastrointestinal disorders; and as adjunctive 
therapy in the management of peptic ulcer, gastritis, duodeni- 
tis, irritable bowel syndrome, spastic colitis, and mild ulcer- 
ative colitis. 

Contraindications: Patients with glaucoma; prostatic hyper- 
trophy and benign bladder neck obstruction; known hyper- 
sensitivity to chlordiazepoxide hydrochloride and/or 
clidinium bromide. 

Warnings: Caution patients about possible combined effects 
with alcohol and other CNS depressants. As with all CNS- 
acting drugs, caution patients against hazardous occupations 
requiring complete mental alertness (e.g., operating machin- 
ery, driving). Though physical and psychological dependence 
have rarely been reported on recommended doses, use cau- 
tion in administering Librium (chlordiazepoxide hydrochlo- 
ride) to known addiction-prone individuals or those who 
might increase dosage; withdrawal symptoms (including con- 
vulsions), following discontinuation of the drug and similar 
to those seen with barbiturates, have been reported. Use of 
any drug in pregnancy, lactation, or in women of childbear- 
ing age requires that its potential benefits be weighed against 
its possible hazards. As with all anticholinergic drugs, an 
inhibiting effect on lactation may occur. 

Precautions: In elderly and debilitated, limit dosage to small- 
est effective amount to preclude development of ataxia, 
oversedation or confusion ( not more than two capsules per 
day initially; increase gradually as needed and tolerated). 
Though generally not recommended, if combination therapy 
with other psychotropics seems indicated, carefully consider 
individual pharmacologic effects, particularly in use of 
potentiating drugs such as MAO inhibitors and phenothia- 
zines. Observe usual precautions in presence of impaired 
renal or hepatic function. Paradoxical reactions (e.g., excite- 
ment, stimulation and acute rage) have been reported in 
psychiatric patients. Employ usual precautions in treatment 
of anxiety states with evidence of impending depression; 
suicidal tendencies may be present and protective measures 
necessary. Variable effects on blood coagulation have been 
reported very rarely in patients receiving the drug and oral 
anticoagulants; causal relationship has not been established 
clinically. 

Adverse Reactions: No side effects or manifestations not 
seen with either compound alone have been reported with 
Librax. When chlordiazepoxide hydrochloride is used alone, 
drowsiness, ataxia and confusion may occur, especially in 
the elderly and debilitated. These are reversible in most 
instances by proper dosage adjustment, but are also occasion- 
ally observed at the lower dosage ranges. In a few instances 
syncope has been reported. Also encountered are isolated 
instances of skin eruptions, edema, minor menstrual irregu- 
larities, nausea and constipation, extrapyramidal symptoms, 
increased and decreased libido— all infrequent and generally 
controlled with dosage reduction; changes in EEG patterns 
(low-voltage fast activity) may appear during and after treat- 
ment; blood dyscrasias (including agranulocytosis), jaundice 
and hepatic dysfunction have been reported occasionally 
with chlordiazepoxide hydrochloride, making periodic blood 
counts and liver function tests advisable during protracted 
therapy. Adverse effects reported with Librax are typical of 
anticholinergic agents, i.e., dryness of mouth, blurring of 
vision, urinary hesitancy and constipation. Constipation has 
occurred most often when Librax therapy is combined with 
other spasmolytics and/or low residue diets. 


\ Roche Laboratories 
ROCHE / Division of Hoffmann-La Roche Inc. 
w / Nutley, New Jersey 07110 


For the anxietydinked 
symptoms of duodenal ulcer 



Each capsule contains 5 mg chlordiazepoxide HC1 
and 2.5 mg clidinium Br. 


Meandering Catheter 

(Continued from page 113) 

and hypertelorism. Palate was highly arched and 
cleft. A grade III/IV systolic murmur was aus- 
cultated at left sternal border. Second and fifth 
fingers overlapped; there were rocker bottom feet 
and bilateral calcaneo valgus deformities. The 
multiple malformations were attributed to a 
trisomy 18. 

An umbilical venous catheter is seen to be in 
an unusual location, crossing the abdomen trans- 
versly with its tip lying in the peritoneal cavity 
(Figure 7) . Death at 48 hours of age was related 
to this catheter complication; at autopsy 100 cc 
blood was found in the peritoneal cavity from 
the umbilical catheter which had ruptured 
through the vein. 

Comment: An unusual position of the catheter 
which does not follow the course of known vas- 
cular channels should suggest possible perfora- 
tion via an umbilical vessel into the peritoneal 
cavity. 

Discussion 

Complications of indwelling catheters are pri- 
marily due to catheter position, timing and 
catheter material. Other factors include catheter 
size, pH and tonicity of infused solutions. 2 
Among complications which have been described 
are thrombosis, embolization, vasospasm, vessel 
and bowel perforation, hemorrhage, liver necro- 
sis and abscess, delayed portal vein thrombosis, 
cardiac arrythymias, perforation of left ventricle, 
paraplegia, breakage of catheters and infec- 
tion. 2 - 13 

Arterial and venous thrombosis comprise the 
most serious and common complications. Wigger, 
reviewing 177 neonatal catheterized patients, re- 
ports a high incidence of 12% autopsy proven 
catheter-related thrombosis. 12 Neal,, et al. de- 
scribe a surprising 95% incidence of thrombosis 
formation demonstrated by hand injection of 
contrast material at time of catheter removal. 7 
Factors involved in production of thrombosis 
include mechanical alterations in blood flow and 
period of time catheter is left in place. No rela- 
tionship between the duration of catheterization 
and occurrence of arterial thrombi has been es- 
tablished. However, mechanical alterations in 
blood flow induced by the rough surfaced, 
thrombogenic, polyethylene vinyl and polyure- 
thane catheters in current use, are thought to be 
strongly related to thrombus formation. Reported 
lesions correspond to level of insertion of the 
catheter and have been described in the um- 
bilical, renal, common iliac arteries and aorta. 
Proper positioning is vital since unavoidable 
thrombi and emboli related to catheter place- 
ment need not be life-threatening if the catheter 


has been properly placed. Emboli which are 
thrown off will go downstream so that placement 
of the tip of the catheter distal to origin of major 
vessels is exceedingly important. 5 ’ 7 

Thrombosis or emboli may be accompanied 
by organ infarctions and death. Umbilical venous 
catheters are particularly dangerous in this re- 
spect if associated with either umbilical infec- 
tions or infusion of hypertonic solutions into the 
portal system; this may result in portal vein 
thrombosis and subsequent portal hypertension. 
Because of the potential hazards of thrombosis 
the tip of catheter should never be allowed to re- 
main in either the umbilical vein, intrahepatic or 
extrahepatic portal veins or cardiopulmonary 
system. Hypertonic fluids at unfavorable pH, or 
toxic bacterial products introduced directly into 
the portal veins may produce actual liver necro- 
sis. Direct infusion of hypertonic glucose or 
bicarbonate solutions can also be potentially 
hazardous to other organ systems. 5 

Catheters coiled within the heart have mul- 
tiple potential dangers; thrombosis, cardiac ar- 
rhythmias, damage to cardiac valves and perfora- 
tion of the myocardium. There has been one 
report of a perforated ventricle due to umbilical 
catheter. 10 

Other perforations, of umbilical vessels or in- 
testine have been recorded. When the catheter 
follows an unusual course into the peritoneum, 
perforation of an umbilical Vessel can be sus- 
pected. If promptly withdrawn there is a good 
chance for complete recovery. 9 Positioning in a 
branch of the portal vein should not be misin- 
terpreted as a perforation, although this in itself 
is an undesirable location. Vascular perforations 
are related to the use of sharp beveled catheters 
and may be prevented by using catheters with 
rounded tips. 9 Perforations of the intestine were 
originally described incident to umbilical cathe- 
terization for exchange transfusions, probably 
related to the catheter tip in the portal vein 
disturbing blood flow and pressure sufficiently to 
produce venous spasm and hypoperfusion with 
subsequent necrotizing enterocolitis and perfora- 
tion. 

Summary 

Umbilical catheterization of newborns should 
be done on carefully selected patients who re- 
quire constant monitoring, infusions or ex- 
changes. Ideal positioning of the catheter is 
vital to help prevent complications and must be 
checked by roentgenograms. Catheters should be 
promptly removed when no longer needed or if 
there is any complication. 

References 

A complete bibliography for “Meandering Catheter” 
may be obtained by writing to: Illinois Medical Journal, 
360 N. Michigan Ave., Chicago, 60601. 


116 


Illinois Medical Journal 



practice management 


The Professional Corporation— Advantages 

and Disadvantages 

By Wagdy Sharkas, CPA, PIi.D/Chicago 


The professional corporation, by definition, is 
a professional business entity intended to provide 
professional services. The controversy of whether 
a physician or a group of physicians should in- 
corporate is still subject to confusion and mis- 
understanding. On one side, incorporation is 
encouraged by the salesmen of retirement plans. 
On the other side, attorneys and accountants are 
still in a state of uncertainty as to which course 
of action is advisable. As such, the question of 
incorporation represents a critical area of con- 
cern for a large segment of the medical profes- 
sion. 

It is the physician’s sole responsibility to 
decide upon whether or not to incorporate. In 
so doing he must weigh carefully the advantages 
and disadvantages of incorporation. The objec- 
tive of this article is to examine thoroughly the 
advantages and disadvantages of incorporation 
under present tax laws and sound business logic. 

Advantages 

In choosing between the corporate or uncor- 
porate form of practice, physicians should be 
aware of the following advantages of incorpora- 
tion: 

1 .Limited Liability: It is legally established 
that the liability to injured parties and third 
parties cannot exceed the assets of an in- 
corporated practice, whereas the unicorpo- 
ra ted practice liability could extend beyond 

WAGDY SHARKAS, CPA, Ph.D., Assistant Professor of Account- 
ing at the University of Illinois, Chicago Circle. Dr. Sharkas is 
a member of the American Institute of Certified Public Ac- 
countants, American Accounting Association, National Associa- 
tion of Accountants, Financial Executive Institute, and the 
American Institute of Decision Sciences. 


the practice assets to include all personal 
assets of the individual physician and all 
of his partners, if any. As a general rule, 
the hardship of liability for malpractice on 
the part of the physicians is usually covered 
by liability insurance, but the possibility 
always exists that enough insurance cover- 
age may not be maintained. 

2. Retirement Plans: Unincorporated practi- 
tioners are limited to a retirement plan con- 
tribution of 10% of their income but not 
exceeding a maximum contribution of 
$2,500. An incorporated practice can con- 
tribute as much as 25% of its covered 
salaries (payroll) without a maximum lim- 
itation. As a matter of fact, an incorporated 
jrractice, under the carryover provisions of 
section 404 (a) (7) of tax laws, can contribute 
up to 30%. 

3. Fringe Benefits: Physicians must consider the 
several fringe benefits available to incor- 
porated practice. An incorporated practice 
can pay tax deductible premiums for dis- 
ability, and health and life insurance on 
the lives of its employees (physicians) and 
their dependents. Other tax deductible 
fringe benefits available to physicians of in- 
corporated practice are: sick pay exclusion, 
$5,000 death benefit exclusion paid to a 
beneficiary, coverage under workmen’s com- 
pensation, and disability insurance plans. 
In considering the effect of the fringe bene- 
fits on whether to incorporate or not, physi- 
cians must evaluate them collectively. The 
fringe benefits individually are small items 
and usually produce immaterial differences 
to be considered. 


for August, 1974 


117 


4. Dividend Income Benefits: Unincorporated 
physicians are taxed in full minus $100 
exclusion on dividend income from their 
investment in stocks (preferred and com- 
mon) . An incorporated practice is exempt 
from taxation on 85% of dividends received 
on the corporation’s investments in domestic 
stocks. For example, if an incorporated 
practice owns stocks in General Motors and 
received $10,000 in dividends from General 
Motors, it has to pay taxes on only $1,500 
of the $10,000. The advantages of incorpora- 
tion can be exhibited in a simplified com- 
parative cash flow statement as follows: 


Exhibit 1 

COMPARATIVE CASH FLOW STATEMENT 


Unincorporated 

Practice 

Incorporated 

Practice 

Net Income From Practice 
Less: Allowable Retirement 

$50,000 

$50,000 

Plan Deduction 

2,500 

9,600 


$47,500 

$40,400 

Less: Fringe Renefits 

-0- 

4,000 


$47,500 

$36,400 

Less: Federal Income Taxes 

15,810 

10,972 


$31,690 

$25,428 

Less: Amount Needed After 



Taxes to Provide Same 
Coverage As Incorporated 
Practice: 


Retirement Plan 

7,100 

-0- 

Fringe Benefits 

4,000 

-0- 

NET AVAILABLE CASH: 

$20,590 

$25,428 


NOTE: The above exhibit assumes that all available cash is 
withdrawn in form of salary, the practice is owned by a married 
physician with no children, and no standard deductions and exemp- 
tions. Nonetheless, Exhibit 1 illustrates the physician with extra 
$4,838 in cash under incorporated practice. In other words, in- 
corporated practice provides 9.68 % more spendable cash on 
net income of $50,000. That is not to say that this rate is constant. 
On the contrary, the rate of more spendable cash will increase 
progressively with the net income increase. 

5. Continuity of Life: The death or incapacity 
of the practioner does not effect the life of 
the incorporated practice. An incorporated 
practice’s life depends on its charter, not 
on the life of its owner (s). An incorporated 
practice has better chances for continuing 
either through sale to an outsider physician 
or through a buy-sell arrangement with other 
physician-owners of the incorporated prac- 
tice. 

6. Use of a Fiscal Year: This factor is not a 
major consideration to decide whether to 
incorporate or not. Yet, there may be some 
initial tax savings as a result of change 
from a calendar year to a shorter fiscal 
period. Also, the use of a fiscal year would 


give the physician and his accountant the 
freedom of selecting the date of year-end 
whereby they can devote more time to 
year-end tax planning. 

Disadvantages 

For a physician to decide upon whether or 
not to incorporate, disadvantages of incorpora- 
tion should be evaluated carefully, The main 
disadvantages of incorporated practice could be 
summarized as follows: 

1 .Requirements of Incorporation: There are 
some initial legal and accounting costs un- 
avoidable upon incorporation. In addition 
to these initial costs, annual costs in form 
of fees will be incurred for the keeping 
of corporate minutes and the filing of 
various annual corporate reports to both 
federal and state agencies. Also, the practice 
must be operated as a corporation and may 
be subject to penalty if this rule is not 
strictly adhered to by the incorporator (s). 

2 . Accumulated Funds Problems: Withdrawing 
funds from an incorporated practice can 
present several problems. If funds are with- 
drawn as salaries, the unreasonableness of 
salary might expose the practice to a serious 
problem with IRS. If cash is not withdrawn 
as salary and left to accumulate within the 
corporation, it may be penalized at the rate 
of 27 1 / 2 % on these accumulated funds in 
excess of $100,000. 

3. Other Disadvanatges: There are many other 
negative factors a physician should consider 
in deciding upon whether or not to incor- 
porate. He should consider such problems 
as the exposure to the vulnerability of per- 
sonal holding company status, on which in- 
come the IRS levies a penalty tax of 70%, 
and, the additional payroll tax cost for both 
social security, and federal and state un- 
employment tax which he will never collect. 

Conclusion 

There is no one answer to the question of 
incorporation on the part of physicians. The 
answer depends on the particular circumstances 
of each physician. Yet as a tentative answer, 
under the present tax laws, the advantages of 
incorporation would seem to outweigh the dis- 
advantages, especially for those whose gross in- 
come is in excess of $100,000. ◄ 


118 


Illinois Medical lournal 


'Dactai ‘Tfecvd 


ISMS HOSTING UNIQUE LEGISLATIVE SEMINAR-ISMS is hosting a unique Legislative 
Seminar September 20-22, 1974, at the Chateau Louise, Dundee. The 
seminar will bring together Illinois physicians, and spouses, to meet infor- 
mally with state legislators and leaders. The purpose of the seminar is to 
afford participants the opportunity to become acquainted with key legis- 
lators and to gain a better understanding of the process of government. 

For details, contact the Public Affairs Committee, ISMS, 360 N. Michigan 
Ave., Chicago 60601; phone 312-782-1654. 

PL93-282 ALCOHOLISM ACT IN EFFECT-The “Comprehensive Alcohol Abuse and Alco- 
holism Prevention, Treatment and Rehabilitation Act (Amendments of 
1974)” is in effect, and hospital administrators should be urged to review 
PL93-282 to ensure compliance with the Act. 

Under PL93-282, all federal funds, including Medicare, Medicaid, etc., 
will be discontinued to hospitals that refuse to treat patients with the dis- 
ease of alcoholism; and all records of patients treated for alcoholism must 
be kept in strict confidence. 

To obtain a copy of PL93-282, contact your IDMH Regional Alcoholism 
Coordinator office. 

DRUG AND ALCOHOL CONFERENCE PLANNED-The Illinois State Medical Society, 
with the cooperation of the McLean County Medical Society, will sponsor 
a two-day workshop/conf erence on drug and alcohol dependencies. The 
programs are designed for medical, paramedical and school personnel; law 
enforcers and community workers. 

The first session begins at 6:00 p.m., October 4, 1974, at the Ramada Inn, 
Bloomington and will feature a problem oriented discussion. The second 
session, Saturday, October 5, 1974, 9:00-4:00 p.m., Union, Illinois State 
University at Normal, will emphasize identification of scope of problem 
with workshop sessions on resource identification and therapeutic com- 
munities. 

For further information, contact the ISMS headquarters, 360 N. Michigan 
Ave, Chicago, 60601; phone 312-782-1654. 

PUBLIC AID ISSUES NEW CARDS— August 1, 1974, the Illinois Department of Public Aid 
replaced the familiar ‘"green card” used by Medicaid patients with a card 
in lighter green color. The purpose of the change is to distinquish public 
aid recipients from food stamp recipients. Physicians are advised not to 
rely solely on the green card for identification purposes, but should request 
additional identification. 

ILLINOIS FOUNDATIONS RECEIVE PSRO GRANTS-The Chicago Foundation for Medi- 
cal Care and the Quad River Foundation for Medical Care (Will, Grundy, 
Kankakee and Kendall counties) have received contracts for development 
of formal plans necessary to qualify as a conditionally designated PSRO. 
CFMC received $225,760 and QRFC received $46,135. 


for August , 1974 


121 


PHYSICIANS IN THE NEWS— Lowell R. King, M.D., has been named Surgeon-in-Chief at 
The Children’s Memorial Hospital, Chicago. 

The Health and Hospitals Governing Commission of Cook County re- 
cently appointed Frank J. Jirka, Jr., M.D., River Forest, as Medical Director 
and Chief of Staff at Oak Forest Hospital, Oak Forest, the world’s largest 
hospital for long-term care. The newly elected Trustee to the American 
Medical Association and Past President of the Illinois State Medical Society, 
Dr. Jirka serves on the President’s Committee on Employment of the 
Handicapped. 

David R. Boyd, M.D., Chief of the Illinois Trauma Network, has been 
named Director of the National Emergency Director of the National 
Emergency Medical Services, HEW. 

F. E. Hirsch, M.D., Chicago and Elizabeth E. Koppenall, M.D., Elmhurst 
are new members of the ISMS Fifty Year Club. 

David F. Fretzin, M.D., Northbrook, and Leon Prinz, M.D., Lincoln- 
wood, have been elected President and Secretary-Treasurer, respectively 
of the Alumni Association of Michael Reese Medical Center. 

Milorad Cupic, M.D., Olympic Fields, is a new Fellow of the American 
College of Anethesiologists. 

Marshall Falk, M.D., is the new Dean at Chicago Medical School. 

Condolence is extended by the ISMS Offices, Trustees and Staff to the 
Dr. James A. McDonald Family in the passing of Mrs. McDonald. Dr. 
McDonald, Geneva, is the Vice Speaker of the ISMS House of Delegates. 

Get Well Wishes are sent to Edward Piszczek, ISMS Past President, who 
recently underwent surgery. 

ISMS CO-SPONSORING “TAP INSTITUTE”— A “Trustee-Administrator-Physician (TAP) In- 
stitute” will be held October 4-5, 1974, O’Hare Regency Hyatt House, 
Chicago. This institute, co-sponsored by the Illinois State Medical Society 
and the Illinois Hospital Association, is designed to help participants 
develop and implement effective internal program to assure the quality of 
care within the hospital. For further information, contact Gaylen Newmark, 
IHA, 840 N. Lake Shore Drive; phone 312-664-9500. 


Dr. Greenhill Receives Achievement Award 

J. P. Greenhill, M.D., 
Chicago, recently received 
the Outstanding Achieve- 
ment Award from the 
Michael Reese Department 
of Obstetrics and Gyne- 
cology. Dr. Greenhill, au- 
thor of a best seller for 
expectant mothers The 
Miracle of Life, was cited 
for his contributions to 
the fields of teaching, ed- 
ucation and patient care. 
He has authored hundreds 
of papers in American and 
foreign journals. For over 
50 years. Dr. Greenhill has 
been the Editor of the 
Yearbook of Obstetrics and 
Gynecology. 


New ISMS Field Service Representative 

Jim Kopriva recently 
joined the ISMS staff as 
Field Service Representa- 
tive. He is a graduate of 
the University of Illinois 
where he received his BA 
in finance. 

As Field Service Repre- 
sentative, Mr. Kopriva as- 
sists the county medical 
societies, notably those 
without executive direc- 
tors, in establishing pro- 
grams; serves as an ISMS 
representative at county 
medical society and hospital staff meetings; further 
coordinates between programs of the state and county 
societies; and works with the membership when any 
problems may arise at the county level. 

County societies that need assistance in any way 
should contact Mr. Kopriva at the ISMS headquarters, 
360 N. Michigan Ave., Chicago, 60601 ; phone, 312- 
782-1654. 




122 


Illinois Medical Journal 



Do you spend 
your vacations 
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Only it takes a little sav- 
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So why not do the smart 
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work and start buying U.S. 
Savings Bonds. You’ll build 
up a vacation fund sooner 
than you think. 

Bonds are a dependable 
way to save. They are guar- 
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destruction, and your savings 
earn a good rate of interest, 
too. 

Buy U.S. Savings Bonds 


through the Payroll Savings 
Plan. You’ll find you won’t 
be sitting at home anymore 
thinking about how good 
your vacations could be. 



inj^merica. 


Buy U. S. Savings Bonds 

Now E Bonds pay 5 Vi% interest when held to maturity 
of 5 years. 10 months (4% the first year). Bonds are 
replaced if lost, stolen, or destroyed. When needed they 
can be cashed at your bank. Interest is not subject to 
state or local income taxes, and federal tax may be 
deferred until redemption. 



The U. S. Government does not pay for this advertisement. 
It is presented as a public service in cooperation with The 
Department of the Treasury and The Advertising Council. 


for August, 1974 


123 


Personnel Development For The 
Illinois Emergency Medical Services System 

By R. R. Hannas, Jr., M.D. /Evanston 


The operation of the Illinois Emergency Medi- 
cal Services System is based on the expanded 
roles of medical and allied health personnel, 
allowing them to function effectively in as many 
situations as possible. The accompanying article 
discusses the program itself. This article reviews 
the personnel being trained to implement the 
program. 

There are five types of personnel being trained 
and utilized in emergency care program around 
the state: 

Emergency Medical Technician-Ambulance 

(EMT-A) 

The EMT-A may have originally been an am- 
bulance driver or attendant, a fireman, a police- 
man, or a private citizen who has volunteered to 
help his community. He or she is trained to be 
the link between the physician and the emer- 
gency patient in the field, to assess medical prob- 
lems and communicate these to the medical 
personnel manning the emergency room. The 
EMT-A provides treatment as directed, and pro- 
ceeds with the safe transport of the patient. 

To be accredited, the EMT-A must have com- 
pleted an 82-hour course, or its equivalent, and 
passed an examination given by the National 
Registry of Emergency Medical Technicians. 

There are approximately 43 training programs 
situated in community colleges and hospitals 
throughout the state. Instructors for the courses 
include physicians, nurses, administrative, and 
legal personnel, usually affiliated with a Trauma 
Center. To date, Illinois has trained about 6,000 
EMT-As, the most in the nation. 

Emergency Medical Technician-Ambulance 

Advanced (Also referred to as EMT-A II or 

Paramedic ) 

This person, already certified as an EMT-A, 
now takes additional courses to learn patho- 
physiologic changes and their correction, rather 
than just symptom treatment. 

R. R. HANNAS, JR., M.D., Vice Chairman for the Illinois State 
Medical Society Committee on Emergency and Disaster Care 
currently is the President of the American College of Emergency 
Physicians and Director of Emergency Services at Evanston Hos- 
pital, Evanston. 


This person is prepared to man a mobile in- 
tensive care unit, to utilize telemetry equipment, 
and be expert in all life-saving procedures. 

The Illinois Department of Public Health is 
the sole accrediting agency for this level, and has 
certified 234 such persons. The training is avail- 
able in 11 Trauma Centers throughout the state. 
Trauma Nurse— (Also referred to as an EMS 

Nurse or Critical Care Specialist) 

The Trauma Nurse is a specialist who has been 
given 4-5 weeks intensive training in the actual 
care and clinical evaluation of the critically in- 
jured patient. Special programs are available for 
RNs at eight Trauma Centers. The state has 
trained 358 Trauma Nurses, and eight Burn 
Nurse Specialists. Several additional specialty- 
courses have been developed to meet the educa- 
tional needs in the other major categories of 
emergent disease and include a 2-week Burn 
Nurse Specialty Course, 3-week Coronary Care 
Workshop, 2-week Acute Renal Care Course, 
and 3-week Perinatal Course. 

Emergency Room Residencies 

Four hospitals, Billings and Northwestern in 
Chicago, St. Francis, Peoria, and Evanston Hos- 
pital, are presently offering residencies for emer- 
gency department physicians. This is a two year 
training program following a year of internship 
with guidelines established by the American Col- 
lege of Emergency Physicians. 

T ra uma Coo rd i nato rs 

The Trauma Coordinator (TC) is usually an 
experienced, usually ex-military trained, adminis- 
trator. His training is in the care and transporta- 
tion of the critically injured. The TC is under 
the supervision of the staff physician. He co- 
ordinates the various components of the EMS 
system in his area, teaches, and handles public 
relations tasks. Each Trauma Center has a 
Trauma Coordinator. 

County medical societies should become in- 
volved in any program which trains medical or 
allied health personnel. These programs need 
physician input as advisors, instructors, and 
evaluators. 

(Continued on page 132 ) 


124 


Illinois Medical Journal 


Illinois Emergency Medical Service System* 
Status Report III (July, 1974) 


By Winifred Ann Pizzano, B.A., Teresa L. Romano, B.S.N., 

John C. Nance, HMC USN (FLT RES), and David R. Boyd, M.D.C.M. 


On July 1, 1971, the State of Illinois embarked 
upon a statewide program to improve the deliv- 
ery of emergency medical services with the initia- 
tion of the Trauma Program. 1 ’ 2 The progress to 
date and the projected future of the Illinois 
Statewide EMS Program are the subject of this 
report. 

The Illinois Trauma-EMS Program became 
operational with the designation of some 50 
general hospitals as Trauma Centers to improve 
the care of the critically injured patient. Strate- 
gically located throughout the state, these centers 
have been specially staffed and equipped to han- 
dle the complex needs of the critically injured 
patient with resuscitation, initial, and definitive 
care being provided by a process of successive 
triage of individual patients from the scene of 
an accident through the trauma hospital network 
of Local, Areawide, Regional, and “Special” Re- 
gional Centers. The most specific critical care 
necessary for all injured patients can be provided 
as clinical problems are identified and designated 
hospitals, specialty care units (e.g., spinal cord, 
burn, etc.) and transportation care resources are 
mobilized. 10 The trauma center approach has 
provided a stimulus for the development of sub- 
system implementation (communications, trans- 
portation, training, etc.) on a sound areawide, re- 
gional, and statewide basis. This trauma center 
systems approach has spread to several neighbor- 
ing states (St. Louis, Mo.; Dubuque, la.; and 

WINIFRED A. PIZZANO, B.A., is Assistant to the Division 
Chief, Division of Emergency Medical Services and Highway 
Safety, Illinois Department of Public Health. TERESA L. ROMA- 
NO, B.S.N., Operations Director for the Division of Emergency 
Medical Services and Highway Safety, IDPH. JOHN C. NANCE, 
HMC, USN (FLT RES) Field Operations Director of the Division of 
Emergency Medical Services and Highway Safety, IDPH. DAVID 
R. BOYD, M.D.C.M., is Chief of the Division of Emergency Medi- 
cal Services and Highway Safety, IDPH, and Assistant Professor 
of Surgery, The Abraham Lincoln School of Medicine of the 
University of Illinois College of Medicine. 

* Supported in part by National Institutes of Health Grant NIH 
GM 18003-01, National Highway Traffic Safety Work Project 
(NHTSA), and Department of Health, Education, and Welfare 
Demonstration Contract HSM 110-72-345. 


Evansville, Ind.) with these communities desig- 
nating a Trauma Center Referral Hospital for 
appropriate services. 

Initial funding for this program was from the 
National Highway Traffic Safety Administration 
(NHTSA) and provided the basic components 
for a network of interlocking trauma care cen- 
ters. The lead agency in the State Health Depart- 
ment, the Division of Emergency Medical Services 
and Highway Safety (EMS-HS), was given the 
responsibility for the development of this pro- 
gram. In July, 1972, the Division o EMS-HS was 
awarded a four million dollar demonstration con- 
tract by the Department of Elealth, Education, 
and Welfare to expand the trauma care system 
to all categories of emergent disease (acute car- 
diac, high-risk infant, poisoning, alcohol and 
drug overdose, and psychiatric emergencies). The 
State of Illinois is now completing an echelon 
program of regionalized emergency health care 
delivery for all types of emergency medical caie 
by emphasizing the critical treatment aspects of 
certain well-identified clinical groups. 11 

The essential emergency medical services sub- 
systems ol hospital categorization, communica- 
tions, transportation, training and education of 
EMS personnel, public education, and evaluation 
are being further developed along regional lines 
and integrated into a total system for the deliv- 
ery of emergency medical services for all cate- 
gories of patients. All EMS programmatic efforts 
integrate these essential subsystems and are 
stylized to meet regional and local needs and ob- 
jectives by utilizing and upgrading existing emer- 
gency care resources. 

The regional program thrust of the Illinois 
statewide EMS effort has been to identify existing 
resources in all hospital facilities and their sur- 
rounding communities through a process of hos- 
pital emergency department categorization and 
areawide planning. After the initial designation 
of some 50 trauma and “special’ trauma centers 
in the rural and metropolitan parts of the state, 
a statewide categorization of all hospitals for 
comprehensive emergency medical care has been 


for August, 1974 


125 


accomplished and is presently undergoing a sec- 
ond annual review and progressive planning 
phase. 4 

Ambulance services providers and their re- 
spective communities across Illinois have accepted 
the national criteria for equipment and training 
of ambulance personnel. 13 Ambulance standards 
legislation, which incorporates federal standards, 
has been reintroduced to the Illinois legislature. 
The “Paramedic” law (PA 76-2295) has been 
amended to a permanent statutory responsibility 
of the Division of EMS-HS. 

Emergency Medieal Transportation 

Primary Response System 

During the past year, the emergency trans- 
portation subsystem has become more clearly 
defined and developed at both the state and local 
levels. The “Ambulance Strategy for Illinois” 5 
described a plan for the development of a com- 
plete statewide primary ambulance coverage 
utilizing existing medical resources and is being 
used as a guideline by the Illinois Department of 
Transportation (IDOT) in awarding of grants 
for ambulances and medical equipment. Over the 
past two years, 90 nationally recommended de- 
sign 13 ambulances have been funded and placed. 
It is projected that an additional 90 ambulances 
will be placed in the coming year following the 
statewide placement strategy. 

To encourage more effective evaluation and 
planning of local emergency transportation sys- 
tems, the Division of EMS-HS has developed a 
set of reporting forms which include an Am- 
bulance Dispatch Record Form, an Ambulance 
Call Report Form, an Emergency Room En- 
counter Form, a Transfer Form, and a Mobile 
Intensive Care Unit Form. Through the use of 
these forms, patient transportation care can be 
more effectively documented and evaluated. 

Secondary Response System 

Over the past two and one-half years, more 
than 400 patients, transplant organs and donors 
have been transferred under emergency condi- 
tions by helicopter. Air medical transport re- 
sources for Illinois now include helicopters of the 
Illinois Department of Transportation (IDOT), 
Chicago Fire Department, Army National Guard, 
Coast Guard, and a Kentucky-based Army Mili- 
tary Assistance to Traffic and Safety (MAST) 
unit. Fixed-wing aircraft operated by civilians, 
Southern Illinois University, IDOT, and the 
Chicago Fire Department have also provided sub- 
stantial assistance. With the recent purchase of 


an additional Bell 206A helicopter, the IDOT 
now provides statewide 24-hour aeromedical cov- 
erage. 

Overland Critical Care Vans (OCCV’s) 3 will 
be stationed in six regional communities and 
provide service to their surrounding regions later 
this year. These special intensive care transpor- 
tation units will provide sophisticated medical 
care for all types of critically ill or injured pa- 
tients during transfer to advanced specialty treat- 
ment centers (e.g., burn, high-risk infants, etc.) 

Emergency Medical Services Planning 

The development of the Trauma-EMS and the 
Comprehensive Health Planning Agency (CHP 
“A” and “B”) programs were initiated simulta- 
neously in Illinois. The development of areawide 
EMS plans (e.g., categorization of hospital cap- 
ability for emergency medical services, communi- 
cations design, and ambulance placement) has 
been integrated with the local CHP “B” plan- 
ning activity whenever possible and feasible. 
Areawide EMS planning and implementation of 
operational programs have evolved concomitant- 
ly and have developed a considerable measure 
of sophistication and effectiveness. At the present 
time, all EMS activities are being generated at 
the local level through the area EMS committee/ 
council structure and reviewed by the Compre- 
hensive Health Planning Agency. 4 The CHP “B” 
Agency is responsible for providing the review 
and comment mechanism. This usually consists 
of an EMS provider-dominated council that in- 
tegrates the planning efforts of the various sub- 
systems committees. 

In Illinois, the hospital areawide EMS commit- 
tee is responsible for initiating the planning 
process by describing the area emergency care 
capability and special care potential of each 
member hospital. This initial identification of 
areawide EMS care capability and triage patterns 
allows the development of projects for the sub- 
systems of transportation, communications, train- 
ing, public education, and program evaluation. 

Hospital categorization and areawide planning 
(40 area plans) have made possible the extension 
of life-saving care from the metropolitan centers 
to the rural parts of Illinois. This program has 
resulted in increased hospital physician coverage 
even in the most rural areas of the state where at 
least one hospital in each EMS areawide plan 
now provides a 24-hour physician in-house to 
support the entire EMS area. Linkages between 
the rural hospitals to established regional spe- 
cialty care centers have resulted in improved pro- 
fessional liaison and transportation care of pa- 


126 


Illinois Medical Journal 


tients with specific care problems not well served 
in the rural hospital. This reorientation of emer- 
gency clinical care capability on an areawide 
basis has provided the essential framework for 
the implementation of communications, trans- 
portation, training, evaluation, and EMS system 
management efforts. 

Communications 

The MERCI network (Medical Emergency 
Communications of Illinois) provides hospital- 
to-hospital and ambulance-to-hospital communi- 
cations to serve the Illinois EMS program. 12 
Through the MERCI network, physicians can 
give medical direction to ambulance attendants 
at the scene and during transport. At completion 
there will be nine regional communications net- 
works, each with its own radio control center 
(NCCC) . The NCCC is equipped with a master 
radio console, which provides medical backup 
and remote control of ambulance radio channels 
and other hospital radios within the net. The 
network provides essential medical control for 
care advice and triage in day-to-day routine erner- 
eencies as well as area wide medical communi- 
cations in natural disasters. 

A MERCI manual has been printed and dis- 
tributed to hospitals and ambulances. 12 There 
are 50 MERCI net hospital stations covering Illi- 
nois. To date, 690 radio-equipped ambulances 
operate in the MERCI system with six completed 
regional nets. Considerable experience has been 
gained with the operational benefits of this re- 
gional and disciplined radio-telephone medical 
control system. At the present time, the Division 
of EMS-HS is providing technical assistance to 
all areas to develop uniform citizen access num- 
bers (911), multiagency central dispatch centers, 
and, where appropriate, radio telemetry for pre- 
hospital mobile intensive care. 

Public Education 

Public education emanates from the develop- 
ment of areawide plans and program implemen- 
tation at the local level. At the state level, the 
Division of EMS-HS offers technical assistance 
through the Trauma Center Newsletter, re- 
gional seminars, and by the distribution of mate- 
rials to interested groups and to the media. 

The T rauma Center Newsletter was first pub- 
lished iu November, 1971, with 26 issues pro- 
duced so far. These have described the many 
and varied facets of the Illinois Statewide Trauma- 
EMS Program, and have had as a primary ob- 
jective the dissemination of information for 
improvement of trauma patient care. 


Education 

Crucial to the success of a program to deliver 
emergency care is development of appropriate 
personnel and education of existing personnel. 
To this end, many activities are being under- 
taken. Training of ambulance attendants is of- 
fered, which are open for basic or advanced 
status, as well as annual refresher courses. 

Nurse specialist education, stylized to the needs 
of particular areas, are offered throughout the 
state. Annual Symposia have been developed, 
with the next in September, in Chicago, for 
Trauma and Critical Care Nurses. Also, nurse 
training grants are given and a pilot 6-month 
Critical Care Nurse Residency will be offered in 
January, 1975. 

Residencies in Trauma Medicine have been 
developed for physicians, utilizing curriculum 
guidelines of the American College of Emergency 
Physicians. Critical Care Fellowships have been 
awarded 14 medical professionals for studies in 
emergency medicine problems. 

Trauma-EMS workshops for physicians are 
scheduled periodically across the state to gain in- 
put from all physicians. These set the stage for 
future development and planning in the overall 
statewide EMS program. All physicians are en- 
couraged to participate. 

Evaluation 

Several studies and data collection programs 
are ongoing, including the Trauma Registry 
and mortality statistics. During the coming year, 
management and program monitoring data will 
be collected through standard data forms and 
inventories. At the end of the contract period 
(July, 1975), a three-year evaluation, including 
management and impact data, will be published. 

A highway death study reported in a recent 
Journal of Trauma Symposium 17 described the 
effectiveness of the program in central Illinois 
during the first year of operation. The special 
emphasis of this report was the effect of the 
changing character of trauma patient distribu- 
tion for all vehicular-related deaths within this 
area of Region 3-A. 

During the study period of this report, the 
central 14 counties in Region 3-A experienced 
an increase in auto accidents (27%) and an 
increase in persons sustaining injury (16%) and 
a decrease in the percentage of deaths (15%). 
Of particular significance was the steady decline 
in (he percentage of deaths per person injured 
from 2.8% to 2.1% for the study period. 

This same tendency has continued in this 
region throughout the second full year of pro- 


tor August, 1974 


127 


gram operation. The initial study protocol re- 
ported above was subsequently expanded to in- 
clude an 18-month preprogram and a 2-year 
operational period in the same 14-connty area. 11 
All highway-related accidents, injuries, and fatali- 
ties in this region were collected for the pre- 
program (control) , implementation, and full 
operation periods from available Illinois death 
records, state police and Department of Trans- 
portation records, as well as the Trauma Regis- 
try. 18 

An overall comparison of the deaths, accidents, 
injuries, and death to injury ratio (%D/I) for 
preprogram and full operation periods has shown 
that while there was an increase in the number 
of accidents (-|-12%) and a slight decrease in 
injuries ( — 1.5%), there was a decrease in 
deaths ( — 10%) and the D/I ratio ( — 7%). 
Every comparable 6-month time period in this 
study (12 time period comparisons) showed im- 
provements in the number of vehicular deaths 
and death to injury ratio, usually in spite of an 
increased incidence of auto accidents. The one 
exception to this overall tendency was the com- 
parison of July to December 1971 and July to 
December 1972, where no change in death rate 
(0%) occurred. During this period, the number 
of accidents decreased ( — 5%) as did injuries 
( — 13%) , and the death to injury ratio increased 
(from 2.5% to 2.9%) . Seasonal effects may have 
a significant influence on these data. 

The most significant six-month period com- 
parison so far observed is the preprogram period 
(January to June 1971) and a comparable full 
program period two years later (January to 
June 1973). This period comparison, two years 
apart, shows significant and remarkable changes. 
The comparisons of the January to June periods 
for the years 1971 to 1973 indicate a 29% de- 
crease in vehicular accident deaths with a 17% 
increase in the number of accidents and a slight 
decrease (1%) in the number of related in- 
juries, and a 28% decrease in the death to 
injury ratio (from 2.5% to 1.8%). 

It appears that signicant decreases in deaths 
from vehicular causes have occurred in Region 
3-A over the hrst two-year period of the Illinois 
Trauma Program. This and other supporting 
data indicate that a significant impact may re- 
sult from a “trauma center’’ approach due to a 
redirection of relatively small numbers of the 
most critically injured patients within a region 
to designated trauma center hospitals. 


Clinical Categories For 
Areawide EMS Planning 

As a recommendation to the Illinois EMS 
Categorization Law (PA 76-1858), all areawide 
plans were asked to address themselves to six 
clinical categories of emergent disease: trauma, 
acute coronary, high-risk infant, poison control, 
drug overdose and alcohol detoxification, and 
psychiatric emergencies. Clinical programs in 
these areas are underway throughout the state 
developed by EMS councils, with technical assis- 
tance from the Division of EMS-HS. 

Cardiac Program 

Since the passage of the “Paramedic Law” 
(PA 77-2295) in October, 1972, several mobile 
intensive care programs have been developed. 
Under this act, hospitals may, with the approval 
of the Illinois Department of Public Health, 
conduct pilot programs in mobile intensive care, 
including the training and supervision of mobile 
intensive care personnel, commonly known as 
paramedics, or EMT-Advanced. The paramedic 
has liability coverage by state law to provide 
advanced life-support including intubation, de- 
fibrillation, and intravenous medication when 
in telemetry and radio contact with a physician 
or nurse. 

There are five operational paramedic programs 
in Cook County and five new programs antic- 
ipated for the downstate area. Four satellite 
hospital programs further complement the Chi- 
cago program with linkages to the five hospital 
base stations transmitting via dedicated telephone 
lines. 

Rural Cardiac Care. Not every hospital can 
economically or clinically support the full-scale 
operation of an intensive coronary care unit. In 
addition to the initial expense of monitoring 
equipment, the continuing major cost of staffing 
a unit with an adequate number of specially 
trained nursing personnel makes the coronary 
care unit unfeasible in the rural community 
hospital. An alternative to this problem appears 
to be remote cardiac care montioring or the 
Outlying Coronary Care Unit concept (OCCU) . 

The OCCEJ is a telephone telemetry system 
utilizing leased telephone lines. The patient’s 
electrocardiogram is continuously monitored at 
the outlying rural hospital (remote monitoring 
unit or RMU) and is transmitted via telephone 
lines to the receiving center in a larger com- 
munity hospital (central monitoring unit or 
CMU) . At the CMU, experienced coronary care 
nurses monitor the EKG signals of patients in 
the remote hospitals around the clock, along 


128 


Illinois Medical Journal 


with their own in-hospital patients. 

The development of OCCU’s is an essential 
cardiac component of the total EMS system in 
Illinois. The presence of large university or 
community hospitals surrounded by smaller, 
more rural hospitals, coupled with the recent 
strides made in areawide planning give Illinois 
a firm base on which to build this system. Moline 
Public Hospital, with its active and continually 
growing coronary care unit, has taken the OCCU 
initiative in Region 1-B. 

Other hospitals have become interested in the 
OCCU concept and have seen its applicability 
to their respective areas. Springfield, Rockford, 
Champaign-Urbana, and Peoria all have sub- 
mitted grant requests for the development of an 
OCCU project and are working closely with the 
Division of EMS-HS in this effort. 

Perinatal (High-Risk Infant ) Program 

A program for the emergency care and transfer 
of neonates has been in existence in Illinois for 
the past 20 years. Under the Division of Family 
Health, Department of Public Health, the pro- 
gram included neonatal centers and a contrac- 
tual transfer arrangement. A new, expanded 
program, coordinated with the existing emer- 
gency transportation system and established for 
the care of both the neonate and the high-risk 
mother, is presently undergoing review by the 
State Comprehensive Health Planning Agency. 
An updated network of perinatal facilities, in- 
cluding comprehensive and intermediate centers, 
will be established. The contractual transfer 
arrangements will be replaced by the emergency 
transportation system developed by the state EMS 
network with a choice of ambulance, helicopter, 
or Overland Critical Care Vans (OCCV’s) de- 
scribed elsewhere in this report. 

Poison Control 

The 92 designated Poison Control Centers in 
the state are being incorporated into the area- 
wide EMS plans. EMS councils are responsible 
for ongoing evaluation and upgrading of this 
clinical program. 

Alcohol , Drug Abuse, and 
Psychiatric Emergencies 

The Departments of Mental Health and Public 
Health will this year introduce a plan to area- 
wide EMS committees for improved care of 
emergency alcohol problems. This will include 
the identification of hospitals capable of provid- 
ing this care, firm referral patterns to rehabilita- 
tion and treatment centers, and public and 


professional education in acute alcoholism. 

Drug abuse and psychiatric emergencies will 
also be incorporated into the EMS system by the 
EMS councils. With this joint planning effort, 
better organized emergency care for these pre- 
viously neglected patients will be realized. 

EMS Councils 

Twenty-three Emergency Medical Services 
Councils have been established in Illinois to 
coordinate EMS planning and encourage more 
effective utilization of medical emergency re- 
sources at the local level. These councils act as 
adviser groups to the EMS providers, at the 
state and local levels. 

Each council has committees identified to 
coordinate hospital categorization and areawide 
hospital emergency services. The public educa- 
tion committee. chairmen have been selected and 
seminars have been held to discuss methods of 
increasing public awareness of the EMS system 
and to assist in the implementation of public 
access mechanisms (e.g., “911”). The communica- 
tion and transportation committees usually have 
duplicate membership as they consider common 
problems, such as the need for central dispatch 
of ambulances, the passage of local ordinances 
regulating ambulance services, and the coordina- 
tion of ambulance services and communications 
resources. The committees on training have eval- 
uated the needs of the professional and para- 
professional emergency medical personnel and 
have encouraged the development of interhos- 
pital educational programs and special interest 
courses. The EMS councils are presently address- 
ing the problems of program evaluation starting 
with EMS resources inventories and EMS process 
measures utilizing the emergency report forms. 
Output studies with Trauma Registry 19 data are 
ongoing and will be further developed statewide. 

Major emphasis of the EMS councils, during 
the past year, has been on the initial organiza- 
tion and establishment of committees and the 
formulation of local program objectives. With 
this basic organizational process near comple- 
tion, program implementation will be continued 
on an even more active level during the coming 
year. 

Summary 

By defining the problems of the critically in- 
jured patient, and by categorizing hospital 
emergency capabilities for specific patient groups, 
significant EMS progress has already been real- 
(Continued on page 132) 


for August, 1974 


129 


Editorials 



Anger 


The late N. C. Gilbert said on many occasions 
that every emotion, except pity, could trigger 
a heart attack. How true. Anger is, perhaps, the 
most lethal of human emotions. This was best 
popularized by John Hunter who said that his 
“life was in the hands of any rascal who chose 
to annoy and tease him”. And there can be no 
doubt that his death was hastened by the violent 
disagreements he had with his colleagues at St. 
George’s Hospital. He died on October 16, 1793 
following a board of governors meeting of St. 
George’s Hospital at which a colleague made 
him the brunt of some disparaging remarks. 

Anger can be an individual or a family affair, 
or a racial, national, or international trait. As 
an intense emotion, it most certainly over- 
stimulates the brain and the harm comes when 
there is no way to let off steam. Having one’s 
say is, perhaps, the best remedy, but this is 
not always possible. Besides, we have already 
experienced the period of anger. Fighting anger 
with anger, however, is better than pent-up 
hostility because stewing about a problem is 
not the answer. 

I believe that anger is as serious a risk factor 
as are cholesterol, hypertension, and cigarette 
smoking. Nowadays, anger is difficult to avoid 
considering our social and political environment. 
Physicians also have their share of complaints 
about the direction in which the practice of 
medicine is going. It is not easy to remain calm 
when buried under tons of paper work, third 
parties, PSRO, government rules and regula- 


tions, the use of generic vs. trade names, and 
the only too real threats of malpractice suits. 

Things are not as they were 10, or even five, 
years ago. And the rules of the game are not 
always honest. But knowing the bad effects of 
anger gives the physician a head start on pre- 
venting the consequences. Professional men 
should be above petty jealousies and it is here 
that the old adage “only dogs get macl” is 
apropos. 

The risks that follow outbursts of anger can 
be minimized by controlling one’s temper. One 
way is to avoid anonymity because humans do 
many silly things when they think no one knows 
them. Every day when driving the car or eating- 
in a restaurant we see examples of this. Dr. 
William B. McGrath suggests that we have our 
names painted prominently on the trunk or sides 
of our cars. 

Cultivating an interest in others also tends 
to lessen anger. In pioneer days, there were many 
ways in which a person could help his neighbor. 
The desire to be helpful is still there. Compas- 
sion and kindness beyond the line of duty brings 
us back to Dr. Gilbert’s observation. If we can’t 
avoid anger, we can at least take pity on others 
so that each of us will benefit. Anyone who gives 
it a little thought will agree that with all of our 
other problems, we certainly do not need a dog- 
eat-dog world. 

T. R. Van Dellen, M.D. 

Editor 


130 


Illinois Medical Journal 


Guest Editorials 


Model Cities Alcoholism Program 
Receives National Grant Award 


Model Cities-CCUO’s Alcoholism Recovery 
and Rehabilitation Program has been awarded 
an additional year of support commencing Sept. 
1, 1974, by the National Institute on Alcohol 
Abuse and Alcoholism of the U.S. Dept, of 
Health, Education, and Welfare, as recently re- 
ported by Erwin A. France, Administrative As- 
sistant to Mayor Daley and Director of Model 
Cities-Chicago Committee on Urban Opportuni- 
ty. 

“This action was based on the Institute’s con- 
sideration of the Model Cities-CCUO Alcoholism 
Program’s past accomplishments and continuing 
progress in meeting goals and objectives,” said 
John C. Wolfe, Ph.D., Director of the Division 
of Special Treatment and Rehabilitation Pro- 
grams. 

Model Cities-CCUO’s free Alcoholism Program 
is well on its way toward becoming the most ef- 


fective in the city in treating the alcoholic and 
his family, according to results seen among 1,000 
participants— the alcoholics and their families— 
who are currently being served by the alcoholism 
programs conducted by 11 of Model Cities- 
CCUO’s Urban Progress Centers. 

Urban Progress Centers offering the Alcohol- 
ism Program are located at 901 W. Montrose 
Ave., 2550 W. North Ave., 1445 N. Clybourn 
Ave., 3952 W. Jackson Blvd., 3138 W. Roosevelt 
Rcl., 10 S. Kedzie Ave., 1935 S. Halsted St., 4622 
S. King Dr., 1030 E. 63rd St., 839 W. 64th St., 
and 9231 S. Houston Ave. 

For further information or assistance, please 
call on our office, (312) 744-3960. 

Mrs. Erma Turner, Director, 
Model Cities CCUO’s Alcoholism Program 
640 N. LaSalle St., Chicago 60610 


Banning the Trampoline in Our Schools 


This is an idea whose time has come: physi- 
cians should take the lead in advocating the com- 
plete ban on the use of the trampoline in our 
schools. Physicians have all but conquered para- 
lytic polio in the United States through mass 
immunization. But what is the point of im- 
munizing against one crippler, while allowing 
our children to become injured or even quad- 
riplegic as the result of trampoline accidents? 

Dr. Walter Stolov, a specialist in rehabilitation 
medicine at the School of Medicine of the LTni- 
versity of Washington advocates the complete 
ban on the use of the trampoline in the physical 
education program of all elementary, junior and 
senior high schools and colleges. The school prin- 
cipals of the largest county in the state of Wash- 
ington have, in fact, banned the trampoline from 
their sports programs. Dr. Stolov has seen seven 
cases of quadriplegia following trampoline acci- 
dents in 13 years of practice. In each case, the 
injury occurred while the student was engaged 
in trampoline activities as part of an organized 
sports program. Most of the quadriplegias oc- 
curred as a result of acute cervical flexion while 
improperly executing a back flip or a somersault. 

Each year about 11,000 persons of all ages in 
the Linked States sustain spinal cord injuries. We 


do not know exactly how many result from 
trampoline injuries. 

The Accident Prevention Committee of the 
American Academy of Pediatrics has gone on 
record in support of Dr. Stolov’s stand that the 
trampoline be completely banned as an or- 
ganized school sport. The chairman of this com- 
mittee, Dr. Robert G. Scherz has stated: “Very 
little is lost if the trampoline is removed as a 
sports activity. Students interested in body con- 
trol athletics can achieve it through the diving 
board, routine gymnastics and the high jump. 
Spotters around the trampoline cannot prevent 
this catastrophic injury from developing because 
it does not occur as a result of falling off the 
trampoline. The injury occurs in the center of 
the trampoline where no one can prevent it.” 

What can doctors in our state do about it? 
First, look into the athletic programs of the 
schools in your community and determine if the 
trampoline is used as an activity. Secondly, find 
out if quadriplegias or other serious neurologic 
injuries have occurred as a result of trampoline 
activity. Thirdly, urge the school board or the 
athletic director of the school to ban the use of 
trampolines in their school. 

Harvey Kravitz, M.D. 


for August , 1974 


131 


Emergency Medical Personnel 

Development . . . 

(Continued from page 124) 

Hospitals participating in an area’s EMS plan 
or part of a system may divide up training re- 
sponsibilities. One hospital may provide the 
EMT-A training and another may take the 
EMT-A II training. Trainees should have their 
clinical hours in the emergency departments to 
which they will be bringing most of their pa- 
tients. 

Team work is most important, and all person- 
nel in a system must know each other and work 
together. 

If you believe that your community or hospital 
should offer a program for the development of 
emergency personnel, contact the Division of 
Health Care Delivery, ISMS Office, -560 N. Michi- 
gan, Chicago, or call 312-782-1654, for informa- 
tion. 

Ed. Note: A complete listing of trauma centers in Illi- 
nois and EM I A EMT-A II, and Trauma Nurse training 
locations will he published in the annual Reference Issue, 
October, 1974, issue of the Illinois Medical Journal. 


Illinois Emergency Medical 
Service Status Report III 

(Continued from page 129) 

ized in Illinois. The Illinois EMS program was 
facilitated by a statewide experience gained in 
the trauma categorization model. The trauma 
program has stimulated sound areawide EMS 
planning based on self-categorization of all 
participating hospital and by incorporating 
plans to account for area EMS deficiencies and 
strengths. Each area plan lias attempted to 
initiate a “systems approach” to the six identified 
major clinical patient groups as outlined above. 
Subsystems development, equipment purchases 
and oilier financial allocations were made to 
support real clinical problems as identified in 
the local and regional EMS plans. The Illinois 
EMS program has demonstrated the roles of 
state and local planning and operations neces- 
sary in order to establish effective local, regional, 
and statewide emergency medical care delivery 
programs. ◄ 

References 

A complete bibliography may be obtained by writing 
the Illinois Medical Journal, 360 N. Michigan Ave., Chi- 
cago, 60601. 



132 


Illinois Medical Journal 




ekg of tlie month 


John R. Tobin, M.D., M.S., Rimgaudas, Nemickas, M.D., 
Patrick J. Scanlon, M.D., John F. Moran, M.S., M.D., 
James V. Talano, M.D.. Sarah Johnson, M.D. and 
Rolf M. Gunnar, M.D., M.S. /Section of Cardiology, 
Loyola University Stritch School of Medicine 






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A 44-year-old female with no prior liistory of heart disease presents to the emer- 
gency room with palpitations. She states the palpitations started abruptly some 
four hours ago and have made her lighteaded. Her blood pressure is 80/40 
mmHg, and she looks pale but alert. The ECG is monitored and right sided 
carotid sinus massage is initiated. The continuous ECG rhythm strip was recorded. 


Questions: 

I. The ECG rhythm strip shows: 

A. Acute myocardial infarction. 

B. Ventricular tachycardia. 

C. Supraventricular tachycardia. 

D. Escape idioventricular beats and pairs of 
premature ventricular beats. 

E. All of the above. 


2, The following statements are true: 

A. Carotid sinus massage is dangerous. 

B. The pairs of premature ventricular beats 
might require lidocaine intravenously. 

C. The arrhythmias here are definite evidence 
for myocardial infarction. 

D. Watchful expectation and ECG monitor- 
ing should be performed. 

E. All of the above. 


( Answers on page 136) 


for August, 1974 


133 


f~~ ISMS Guide to 

Continuing Medical Education 

Compiled for Illinois physicians by the 
ILLINOIS COUNCIL ON CONTINUING MEDICAL EDUCATION 
360 No. Michigan Ave. • Chicago, IL 60601 • (312] 782-1654 


Items for this Calendar must be received 90 days prior to the event. Those received earlier may appear in up to three 
monthly issues. 

If your organization’s CME activities are not listed— please contact us. To avoid possible conflicts, you’re invited also 
to consult our pie of future events. 

WARNING! Items for this Calendar come from many sources, often far in advance of the publication date. Some- 
times, cancellations or changes in date, place or time occur too late to be corrected before publication. You are urged 
to contact the sponsoring organization to conprm information given below. 



SEPTEMBER 


Alcoholism 

ALCOHOLISM 

For: All Physicians, Allied Health. Weekly medical 
education seminar, Sept. 24, 1974, 11:30 AM, Me- 
morial Hospital of DuPage County, Elmhurst, III. 
Speaker: Herbert Neuhaus, M.D., Dept, of Public 
Health Hosp., Chicago. Hrs. of Instr.: 1. CME Credit: 
AMA Category 1. Sponsor, contact: John H. Huss, 
M.D., DME, Memorial Hospital of DuPage County, 
Avon Rd. & Schiller St., Elmhurst, IL 60126. 


Cardiology 

ARRHYTHMIAS AND ANESTHESIA 

For: All physicians, nurses. Lecture, Sept. 11, 1974, 
Martha Washington Hospital, Chicago. CME Credit: 
1 hr. AMA Category 1, AAFP. Sponsor, contact: F. 
Lopez-Fernandez, M.D., Med. Dir., Martha Washington 
Hospital, 4055 N. Western Ave., Chicago 60618; (312) 
583-9000, ext. 331. 

CARDIOVASCULAR DISEASES 

For: All physicians. Lecture, group discussion, Sept. 
13, 10 AM, S.R. Forkosh Hospital; Sept. 13, 6 PM. 
Lincolnwood Hyatt House; Sept. 14, 10 AM, Bethany 
Methodist Hospital. Speaker: G. T. Gau, M.D., Mayo 
Clinic. CME Credit: 5 hrs. AMA Category 1. Fee: $10 
(non-staff, for dinner). Reg. Deadline: Sept. 9, 1974. 
Sponsor: FAB'-CME. Contact: Mr. S. Plotner, S. R. 
Forkosh Hospital, 2544 W. Montrose, Chicago, IL 
60618; (312) 267-2200. 

INTERNATIONAL SYMPOSIUM ON 
EPIDEMIOLOGY OF HYPERTENSION 

For: All Physicians, Epidemiologists. 3-day symposium, 
Sept. 18-20, 1974, Sheraton-Blackstone Hotel, Chi- 
cago. Fee: $150 ($75 students). Sponsor, contact: 
Helen Heck, Chicago Heart Association, 22 W. Madison 
St., Chicago, IL 60602. 

INTERMEDIATE CARDIOLOGY 

For: All Physicians. 4 V 2 -day course, Sept. 23-27, 
1974, Chicago, Hrs. of Instr.: 32 approx. CME Cred- 
it: AMA Category 1. Fee: $175. Sponsor, contact: 
Cook County Grad Sch. of Med., 707 S. Wood St., 
Chicago, IL 60612. 


Emergency Care 

EMERGENCY ROOM MEDICINE 

For: Internists, Emergency Physicians, Sept. 16-18, 
1974, Arlington Park Towers Hotel, Arlington Hts., 
III. CME Credit: 22 hrs. AMA Category 1. Fee: $100 
mbrs.; $150 non mbrs. Reg. Limit: 300. Sponsor, 
contact: Registrar, Postgrad. Courses, Amer. Coll, of 
Physicians, 4200 Pine St., Philadelphia, PA 19104. 
Co-sponsors: Amer. Coll, of Surgeons, Loyola Univ. 
Stritch Sch. of Med. 


General Interest 

MEDICAL-LEGAL ASPECTS IN PRACTICE OF MEDICINE 
For: All physicians, nurses. Lecture, Sept 4, 1974, 
Martha Washington Hospital, Chicago. CME Credit: 
1 hr. AMA Category 1, AAFP. Sponsor, contact: F. 
Lopez-Fernandez, M.D., Med. Dir., Martha Washington 
Hospital, 4055 N. Western Ave., Chicago 60618; (312) 
583-9000, ext. 331. 


Internal Medicine 

REVIEW COURSE IN RHEUMATOLOGY 
For: Family Physicians. 1-week course, Sept. 9-13, 
1974, Chicago. Hrs. of Instr.: 35 approx. CME Cred- 
it: AMA Category 1. Fee: $200. Sponsor, contact: Cook 
County Grad. Sch. of Med., 707 S. Wood St., Chi- 
cago, IL 60612. 

REVIEW COURSE IN PULMONARY 

For: Family Physicians. 1-week course, Sept. 9-13, 
1974, Chicago. Hrs. of Instr.: 35 approx. CME Cred- 
it: AMA Category 1. Fee: $200. Sponsor, contact: 
Cook County Grad. Sch. of Med., 707 S. Wood St., 
Chicago, IL 60612. 

RECENT CONCEPTS IN DIABETIC MANAGEMENT 

For: All Physicians, Allied Health. Weekly medical 
education seminar, Sept. 10, 1974, 11:30 AM, Me- 
morial Hospital of DuPage County, Elmhurst, III. 
Speaker: Ann M. Lawrence, M.D., Univ. of Chicago. 
Hrs. of Instr.: 1. CME Credit: AMA Category 1. 
Sponsor, contact: John H. Huss, M.D., DME, Me- 
morial Hospital of DuPage County, Avon Rd. & 
Schiller St. , Elmhurst, IL 60126. 

REVIEW COURSE IN HEMATOLOGY 

For: Family Physicians. 1-week course, Sept. 30-0ct. 
4, 1974, Chicago. Hrs. of Instr.: 35 approx. CME 

Credit: AMA Category 1. Fee: $200. Sponsor, con- 
tact: Cook County G'rad. Sch. of Med., 707 S. Wood 
St., Chicago, IL 60612. 

REVIEW COURSE IN INFECTIOUS DISEASES 

For: Family Physicians. 1-week course, Sept. 30-Oct. 
4, 1974, Chicago. Hrs. of Instr.: 35 approx. CMiE 

Credit: AMA Category 1. Fee: $200. Sponsor, con- 
tact: Cook County Grad. Sch. of Med., 707 S. Wood 
St., Chicago, IL 60612. 

REVIEW COURSE IN NEPHROLOGY 

For: Family Physicians. 1-week course, Sept. 30-0ct. 
4, 1974, Chicago. Hrs. of InStr.: 35 approx. CME 

Credit: AMA Category 1. Fee: $200. Sponsor, contact: 

Cook County Grad Sch. of Med., 707 S. Wood St., 
Chicago, IL 60612. 


Neurology 

SPECIALTY REVIEW IN NEUROLOGY— CLINICAL 

For: All Physicians. 1-week course, Sept. 9-13, 1974, 
Chicago. Hrs. of Instr.: 44 approx. CME Credit: AMA 
Category 1. Fee: $200. Sponsor, contact: Cook County 
Grad. Sch. Med., 707 S. Wood St., Chicago 60612. 


Obstetrics /Gynecology 

BASIC GYNECOLOGY 

For: All Physicians. 1-week course, Sept. 16-20, 1974, 
Chicago Hrs. of Instr.: 35 approx. CME Credit: AMA 
Category 1. Fee: $200 Sponsor, contact: Cook County 
Grad. Sch. Med., 707 S. Wood St., Chicago 60612. 


Occupational Medicine 

34TH CONGRESS ON OCCUPATIONAL HEALTH 

For: Industrial Physicians, Nurses, & Safety Engineers. 
Symposium-workshop, Sept. 9-10, 1974, Marriott Mo- 
tor Hotel, Chicago. CME Credit: 12 hrs. AMA Cate- 
gory 1 Fee: $20 Sponsor, contact: Henry F. Howe, 
M.D., AMA Dept, of Environmental, Public, & Oc- 
cupational Health, 535 N. Dearborn St., Chicago, IL 
60610. Co-sponsor: Nat’l. Institute for Occupational 
Safety & Health, U.S. Dept, of HEW. 


Pediatrics 

COMPREHENSIVE CHILDHOOD TRAUMA SYMPOSIUM 

For: All Physicians. 2-day symposium, Sept. 11-12, 
1974, Stouffer's Inn, Indianapolis. Hrs. of Instr.: 14. 
CME Credit: AMA Category 1. Sponsor, contact: Mr. 
John Roscoe, Program Co-ord., Indiana Univ. Sch. of 
Med., 1100 W. Michigan St., Indianapolis, IN 46202. 


Plastic Surgery 

REVIEW COURSE IN PLASTIC SURGERY 

For: Plastic Surgeons. 3-day lecture series, Sept. 3- 
5, 1974, McGaw Med. Cntr., Northwestern Univ., 
Chicago. Hrs. of Instr.: 18 V 2 - Fee: $200. Reg. Dead- 
line: July 31, 1974. Sponsor: Dept, of Surgery, 
Northwestern Univ. Med. Sch. Contact: D. A. Ker- 
nahan, M.D., Childrens Memorial Hospital, 2300 Chil- 
drens Plaza, Chicago, IL 60614. 

MANAGEMENT OF INDUSTRIAL HAND INJURIES 

For: Family Physicians, Plastic Surgeons. Symposium, 
Sept. 14, 1974, Barnes Hospital, St. Louis. Sponsor, 
contact: Paul M. Weeks, M.D., Director, Milliken 
Hand Rehab. Cntr., 907 Wohl Clinic, 4960 Audubon 
Ave., St. Louis, MO 63110. Co-sponsor: Washington 
Univ. Sch. of Med. 


Psychiatry 

CURRENT & FUTURE PERSPECTIVES IN 
TREATMENT OF ALCOHOLISM 

For: All Physicians. Lecture, Sept. 18, 1974, 7:30 
PM, Forest Hosp. Professional Cntr., Des Plaines, III. 
Speaker: R. J. Catanzaro, M.D., The Palm Beach 
Institute, Florida. Fee: $15 ($5 students). Sponsor, 
contact: Forest Hospital, 555 Wilson Lane, Des 

Plaines. IL 60016; (312) 827-8811, ext. 362. 


Surgery 

MANAGEMENT OF COMPLICATIONS IN SURGERY 

For: All Physicians. 4 day course, Sept. 16-19, 1974, 
Chicago. Hrs. of Instr.: 28 approx. CME Credit: AMA 
Category 1. Fee: $175. Sponsor, contact: Cook County 
Grad. Sch. Med., 707 S. Wood St., Chicago 60612. 

UPPER MIDWEST REVIEW OF GASTROENTEROLOGY 

For: All Physicians. 1 ‘/ 2 -day lecture & discussion, 
Sept. 21-22, 1974. Pfister Hotel, Milwaukee. CME 
Credit: 10 hrs. AAFP. Fee: $125. Sponsor, contact: 
The Medical College of Wisconsin, c/o A. T. Fin- 
negan, Course Coord., 561 N. 15th St., Milwaukee, 
Wl 53233. 

FLUID & ELECTROLYTE MANAGEMENT 

For: AH Physicians. 1-week course, Sept. 23-27, 1974, 
Chicago. Hrs. of Inst.: 30 approx. CME Credit: AMA 
Category 1. Fee: $200. Sponsor, contact: Cook County 
Grad. Sch. Med., 707 S. Wood St., Chicago 60612. 

DISEASES OF ESOPHAGUS, STOMACH & DUODENUM 

For: All Physicians. 3-day course, Sept. 26-28, 1974, 
Chicago. Hrs. of Instr.: 20 approx. CME Credit: AMA 
Category 1. Fee: $125. Sponsor, contact: Cook County 
Grad. Sch. Med., 707 S. Wood St., Chicago 60612. 

SPECIALTY REVIEW IN GEN. SURGERY— PART I 

For: Surgeons. 2-week course, Sept. 30-0ct. 11, 

1974, Chicago. Hrs. of Instr.: 94 approx. CME Credit: 
AMA Category 1. Fee: $350. Sponsor, contact: Cook 
County Grad. Sch. of Med., 707 S. Wood St., Chi- 
cago, IL 60612. 


134 


Illinois Medical Journal 


OCTOBER 


Anesthesiology 

COURSE III— EKG FOR ANESTHESIOLOGISTS 
For: Anesthesiologists. 1-week course, Oct. 28-Nov. 1, 
1974, Chicago. CME Credit: 35 hrs. (approx.) AMA 
Category 1. Fee: $200. Reg. Limit: 35. Sponsor, 
contact: Cook County Grad. Sch. of Med., 707 S. 
Wood St., Chicago, IL 60612. 

ACUPUNCTURE ANESTHESIA 

For: All physicians, allied health. Weekly seminar, 
Oct. 29, 1974, Memorial Hospital of DuPage Co., 
Elmhurst, III. Speaker: H. Havdala, M.D., Mt. Sinai 
Hosp. CME Credit: 1 hr. AMA Category 1. Sponsor, 
contact: J. H. Huss, M.D., Dir. Med. Educ., Mem. 
Hosp. of DuPage Co., Avon Rd. & Schiller St. , Elm- 
hurst, IL 60126; (312) 833-1400, ext. 556. 

Cancer 

TUMORS OF URINARY TRACT 

For: All Physicians. Symposium, Oct. 16, 1974, 

Ruth Lake Country Club, Hinsdale, III. CME Credit: 
3 hrs. AMA Category 1. Reg. Deadline: Oct. 14, 
1974. Sponsor, contact: DuPage County Medical Soc., 
646 Roosevelt Rd., Glen Ellyn, IL 60137. 

Cardiovascular 

REHABILITATION FOR RECENT ACUTE 
MYOCARDIAL INFARCTION 

For: All physicians, nurses. Lecture, Oct. 25, 1974, 
Martha Washington Hosp., Chicago. CME Credit: 1 hr. 
AMA Category 1. Sponsor, contact: F. Lopez-Fernan- 
dez, M.D., Med. Dir., Martha Washington Hospital, 
4055 N. Western Ave., Chicago, IL 60618. 

BASIC ELECTROCARDIOGRAPHY 

For: Family Physicians 1-week course, Oct. 28-Nov. 
1, 1974, Chicago. CME Credit: 35 hrs. (approx.) 
AMA Category 1 Fee: $200. Reg. Limit: 35. Sponsor, 
contact: Cook County Grad. Sch. of Med., 707 S. 
Wood St., Chicago, IL 60612. 

Dermatology 

BASIC DERMATOLOGY 

For: Family Physicians. 1-week course, Oct. 14-18, 
1974, Chicago. CME Credit: 30 hrs. (approx.) AMA 
Category 1. Fee: $175. Reg. Limit: 30. Sponsor, 
contact: Cook County Grad. Sch. of Med., 707 S. 
Wood St., Chicago, IL 60612. 

Drug Dependencies 

CONFERENCE ON DRUG & ALCOHOL DEPENDENCIES 

For: All physicians, allied health, school & community 
workers. Symposium & workshop, Oct. 5, 1974 (plus 
Oct. 4, for school personnel only), Student Union, 
Illinois State Univ., Normal, III. CME Credit: 6 hrs. 
AMA Category 2. Fee: $5 (plus lunch). Reg. Dead- 
line: Sept. 27, 1974. Sponsor, contact: Committee on 
Alcoholism & Drug Dep., III. State Med. Soc., 360 
N. Michigan Ave., Chicago 60601; (312) 782-1654. 
Co-sponsors: McLean County Med. Soc. 

Endocrine-Metaholism 

THYROID DISEASE 

For: Family Physicians, Internists, Pediatricians, Nu- 
clear Medicine. 1 V 2 ■ day lecture/round table, Oct. 11- 
12, 1974. Pfister Hotel, Milwaukee, Wis. CME Credit: 
10 hrs. AAFP. Fee: $125. Reg. Limit: 100. Sponsor, 
contact: Medical Coll, of Wis., c/o A. T. Finnegan, 
Ofc. of Cont. Educ., 561 N. 15th St., Milwaukee, 53233. 

SODIUM & WATER METABOLISM 
For: All physicians, allied health. Weekly seminar, 
Oct. 15, 1974, Memorial Hospital of DuPage Co., 
Elmhurst, III. Speaker: A. R. Lavender, M.D., Hines 
V.A. Hospital. CME Credit: 1 hr. AMA Category 1. 
Sponsor, contact: J. H. Huss, M.D., Dir. Med. Educ., 
Mem. Hosp. of DuPage Co., Avon Rd. & Schiller St., 
Elmhurst, IL 60126; (312) 833-1400, ext. 556. 

General Interest 

NEWER CONCEPTS OF THE CLINICAL PHARMACIST 
For: All Physicians & Allied Health. Weekly seminar, 
Oct. 1, 1974, 11:30 AM, Memorial Hospital of Du- 
Page Co., Elmhurst, III. CME Credit: 1 hr. AMA 
Category 1. Sponsor, contact: John H. Huss, M.D., 
DME, Memorial Hospital of DuPage Co., Avon Rd. 
& Schiller St., Elmhurst, IL 60126; (312) 833-1400. 

THE OTHER DOCTOR IN YOUR PRIVATE PRACTICE 

For: All Physicians & Allied Health. Weekly seminar, 
Oct. 8, 1974, 11:30 AM, Memorial Hospital of Du- 
Page Co., Elmhurst, III. CME Credit: 1 hr. AMA 
Category 1. Sponsor, contact: John H. Huss, M.D. , 
DME, Memorial Hospital of DuPage Co., Avon Rd. & 
Schiller St., Elmhurst, IL 60126; (312) 833-1400. 


General Interest /CME Methods 

INTRODUCTION TO CME TECHNIQUE 
For: Hospital and other CME program planners. Two 
identical workshops held simultaneously, Oct. 4-6, 
1974, Marriott Inn, St. Louis and Oak Brook Hyatt 
House, Oak Brook, III. CME Credit: 14 hrs. AMA 
Category 1 (plus 4 hrs. extra on completion of post- 
workshop assignment). Fee: $125. Reg. Limit; Dead- 
line: 20 each; Sept. 20, 1974. Sponsor, contact: 
Illinois Council on Cont. Med. Educ., 360 N. Michi- 
gan Ave., Chicago, IL 60601. 


Nuclear Medicine 

ADVANCES IN DISEASE DETECTED BY 
NUCLEAR SCANNING 

For: All physicians. Frontiers of Medicine lecture, 
Oct. 9, 1974, Billings Hosp., Chicago. CME Credit: 
3 hrs. AMA Category 1, AAFP. Fee: $15. Sponsor, 
contact: Frontiers of Med., Univ. of Chicago, Box 
451, 950 E. 59th St., Chicago 60637. 


Obstetrics-Gynecology 

POSTGRAD COURSE IN OB-GYN 
For: Ob/Gyn. Lecture, case presentation, discussion, 
Oct. 24-26, 1974, Cntr. for Cont. Educ., Univ. of 
Chicago, Chicago. CME Credit: 33 hrs. (approx.) AMA 
Category 1. Fee: $225. Sponsor, contact: F. P. Zus- 
pan, M.D., Chicago Lying-In Hosp., Univ. of Chicago, 
5841 S. Maryland Ave., Chicago, IL 60637. 

SPECIALTY REVIEW IN OB-GYN 

For: Specialists. 2-week course, Oct. 28-Nov. 8, 
1974, Chicago. CME Credit: 86 hrs. (approx.) AMA 
Category 1. Fee: $350. Reg. Limit: 85. Sponsor, 
contact: Cook County Grad. Sch. of Med., 707 S. 
Wood St., Chicago, IL 60612. 


Orthopaedics 

MANAGEMENT OF COMMON FRACTURES 

For: Family Physicians. 1-week course, Oct. 28-Nov. 
1, 1974, Chicago. CME Credit: 30 hrs. (approx.) 
AMA Category 1. Fee: $200. Reg. Limit: 30 Sponsor, 
contact: Cook County Grad. Sch. of Med., 707 S. 
Wood St., Chicago, IL 60612. 


Pediatrics 

MANAGEMENT OF PEDIATRIC HEART DISEASE 

For: All Physicians. 3-day course, Oct. 30-Nov. 1, 
1974, Chicago. CME Credit: 21 hrs. (approx.) AMA 
Category 1. Fee: $100. Reg. Limit: 45. Sponsor, 
contact: Cook County Grad. Sch. of Med., 707 S. 
Wood St., Chicago, IL 60612. 


Psychiatry 

PSYCHIATRY FOR THE MEDICAL PRACTITIONER 

For: All Physicians. 4-day course, Oct. 7-10, 1974, 
Chicago. CME Credit: 24 hrs. (approx.) AMA Cate- 
gory 1. Fee: $175. Reg. Limit: 80. Sponsor, con- 
tact: Cook County Grad. Sch. of Med., 707 S. Wood 
St., Chicago, IL 60612. 

CURRENT & FUTURE PERSPECTIVES IN DRUG ABUSE 

For: All Physicians. Lecture, Oct. 16, 1974, 7:30 
PM, Forest Hospital Professional Cntr., Des Plaines, 
III. Speaker: P. G. Bourne, M.D., Special Action 
Ofc. for Drug Abuse Prevention, Washington, D.C. 
Fee: $15 ($5 students). Sponsor, contact: Forest 
Hospital, 555 Wilson Lane, Des Plaines, IL 60016; 
(312) 827-8811, ext. 362. 

PSYCHOPHARMACOLOGY 

For: Family Physicians, Specialists. Seminar, Oct. 16, 
1974, Indiana Univ. N.W. Campus, Merrillville, Ind. 
CME Credit: 6 hrs. AMA Category 1. Sponsor, con- 
tact: Mr. John Roscoe, Program Coord., Indiana 

Univ. Sch. of Med., 1100 W. Michigan St., India- 
napolis, IN 46202 

PSYCHIATRY FOR THE ADOLESCENT 

For: All Physicians. Lecture, group discussion, Oct. 
23, 1974, 10 AM, Bethany Methodist Hosp.; Oct. 
23, 6 PM. Lincolnwood Hyatt House; Oct. 24. 10 AM, 
Belmont Hosp Speaker: Beverley Mead, M.D., Dept, 
of Psychiatry, Creighton Univ. Sch. of Med. CME 
Credit: 5 hrs. AMA Category 1. Fee: $10 (non- 
staff, for dinner). Reg. Deadline: Oct. 18, 1974. 
Sponsor: FAB 3 -CME. Contact: Mr. D. Larson, Bethany 
Methodist Hosp., 5025 N Paulina, Chicago, IL 60640; 
(312) 271-9040. 


Surgery 

PRE & POSTOPERATIVE CARE OF PATIENTS 

For: Surgeons, Surgical Specialists. 4-day course, 

Oct. 29-Nov. 1, 1974, Chicago. CME Credit: 32 hrs. 
(approx.) AMA Category 1. Fee: $175. Reg. Limit: 80. 
Sponsor, contact: Cook County Grad. Sch. of Med., 
707 S. Wood St., Chicago, IL 60612. 


NOVEMBER 


Alcoholism 

FIRST ANNUAL SYMPOSIUM ON ALCOHOLISM 

For: All physicians. Nov. 13, 1974, 9:00-11:00 AM, 
Robt. C. Hartmann, Sr., Auditorium, Martha Washing- 
ton Hosp , Chicago. CME Credit: 2 hrs. AMA Category 
1, AAFP Elective. Reg. Limit: 110. Sponsor, contact: 
F. Lopez-Fernandez, M.D., Med. Dir., Martha Wash- 
ington Hosp., 4055 N. Western Ave., Chicago, IL 
60618; (312) 583-9000, ext. 331. 

Dermatology 

CUTANEOUS MEDICINE 

For: All physicians. Frontiers of Medicine lecture, Nov. 
13, 1974, Billings Hospital, Chicago. CME Credit: 3 
hrs. AMA Category 1, AAFP. Fee: $15. Sponsor, con- 
tact: Frontiers of Medicine, Univ. of Chicago, Box 
451, 950 E. 59th St., Chicago 60637. 

Family Medicine 

FAMILY PRACTICE REVIEW 

For: Family Physicians. Nov. 4-8, 1974, Chicago. 
CME Credit: 40 hrs. (approx.) AMA Category 1. Fee: 
$175. Reg. Limit: 50. Sponsor, contact: Cook County 
G'rad. Sch. of Med., 707 S. Wood St., Chicago 60612. 

Internal Medicine 

BASIC INTERNAL MEDICINE 

For: All physicians. Nov. 11-15, 1974, Chicago. CME 
Credit: 40 hrs. (approx.) AMA Category 1. Fee: $175. 
Reg. Limit: 50. Sponsor, contact: Cook County Grad 
Sch. of Med., 707 S. Wood St., Chicago 60612. 

ADVANCES IN MEDICINE 

For: Specialists. Nov. 18-22, 1974, Chicago. CME 
Credit: 35 hrs. (approx.) AMA Category 1. Fee: $175. 
Reg. Limit: 50. Sponsor, contact: Cook County Grad. 
Sch. of Med., 707 S. Wood St., Chicago 60612. 

Laryngology 

LARYNGOLOGY & BRONCHOESOPHAGOLOGY 

For: All physicians. Symposium, Nov. 18-23, 1974, 
Chicago. Hrs. of Instr.: 42. Fee: $300. Reg. Limit, 
Deadline: 20; Nov. 17, 1974. Sponsor, contact: Univ. 
of III. Abraham Lincoln Sch. of Med., 1855 W. 
Taylor St., Chicago, IL 60612. 

Neurology 

NEUROPHYSIOLOGICAL & CLINICAL 
ASPECTS OF ACUPUNCTURE 

For: Physicians, Surgeons, Dentists. 3-day conference, 
Nov. 7-9, 1974, Hilton Hotel, Madison, Wis. CME 
Credit: AAFP Prescribed, AMA Category 1. Fee: $90 
(before Sept. 1); $110 (after Sept. 1). Sponsor, con- 
tact: Dept, of Cont. Med. Educ., Univ. of Wis., 610 
N. Walnut St., Madison, Wl 53706. 

Obstetrics-Gynecology 

FEMALE CLIMACTERIC 

For: All physicians, allied health. Weekly seminar, 
Nov. 19, 1974, Memorial Hospital of DuPage Co., 
Elmhurst, III. Speaker: A Scommegna, M.D., Michael 
Reese Hosp CME Credit: 1 hr. AMA Category 1. Spon- 
sor, contact: J H. Huss, M.D., Dir. Med Educ., 
Mem. Hosp. of DuPage Co., Avon Rd. & Schiller St., 
Elmhurst, IL 60126; (312) 833-1400, ext. 556. 

Pediatrics 

GENERAL PEDIATRICS 

For: All physicians. Nov. 18-22, 1974, Chicago. CME 
Credit: 35 hrs. (approx.) AMA Category 1. Fee: $175. 
Reg. Limit: 30. Sponsor, contact: Cook County Grad. 
Sch. of Med., 707 S. Wood St., Chicago 60612. 

Psychiatry 

ON DEATH & THE CONTINUITY OF LIFE 

For: All physicians. Lecture, discussion, Nov. 20, 
1974, 7:30 PM, Forest Hosp Professional Cntr., Des 
Plaines, III. Speaker: R. Lifton, M.D., Yale Univ. 
Fee: $15 ($5 students). Sponsor, contact: Forest 
Hosp., 555 Wilson Lane, Des Plaines, IL 60016. 

Surgery 

BLOOD VESSEL SURGERY 

For: Specialists. Nov. 18-22, 1974, Chicago. CME 

Credit: 40 hrs. (approx.) AMA Category 1. Fee: $300. 
Reg. Limit: 40. Sponsor, contact: Cook County Grad. 
Sch. of Med., 707 S. Wood St., Chicago 60612. 

SPECIALTY REVIEW, PART I 

For: Specialists. Nov. 4-15, 1974, Chicago. CME 

Credit: 94 hrs. (approx.) AMA Category 1. Fee: $350. 
Reg. Limit: 150. Sponsor, contact: Cook County Grad. 
Sch. of Med., 707 . Wood St., Chicago 60612. 


for August, 1974 


135 


Alcoholism— A General 
Hospital Meets the Challenge 

(Continued from page 99) 

which the patient was introduced at Little Com- 
pany of Mary Hospital. 

Goals and expectations of this program con- 
sist of a recovery rate which is accep table for an 
effective alcoholism program. This general hospi- 
tal program is not a short time treatment process, 
but must be looked upon as the entry point to 
long term treatment, either as an outpatient with 
A.A. involvement and professional counseling, or 
as an inpatient in one of the alcoholism rehabili- 
tation centers. 

Summary 

This care of alcoholism will conform to the 
standards of such care set by the Joint Commis- 
sion on Accreditation of Hospitals. The two com- 
ponents of care which this, and any other gen- 
eral hospital can provide, are emergency care and 
after-care. 

Some of the more elaborate psychosocial group 
therapeutics at Little Company of Mary Hospi- 
tal would not be necessary for all general hospital 
programs. Local volunteer A.A. people from the 
community can provide much good counseling 
and many hospitals now have A.A. groups which 
meet in the hospital area. Ideally, every general 
hospital should take care of the acute alcoholism 
patient in the community, and establish an after- 
care system which would include an alcoholism 
rehabilitation center to which patients, who re- 
quire more than a short inpatient experience, 
could be referred. A good rehabilitation center 
can serve a constellation of referring general hos- 
pitals. General hospitals would then be providers 
of acute care lor which most of them have been 
designed. 

This program for the general hospital care of 
acute alcoholism has served a large number of 
patients and is proving to be a feasible method of 
serving its community. The average daily census 
of acute alcoholism patients in this 550 bed hos- 
pital runs about 6 patients. This census figure re- 
mains generally low because of the short stay. 
The therapy sessions are also attended by those 
patients who are in the hospital for other condi- 
tions, but who suffer concommitantly from alco- 
holism, or whose alcoholism has been uncovered 
by a perceptive physician. 

Finally, training opportunities are available 
for physicians and other professionals, so that all 
general hospitals, who seek to meet the challenge 


of treating their community alcoholism patients, 

can attain this goal. ^ 

References 

Block, Marvin A., M.D., Alcoholism— Its Facets and 
Phases, John Day Co. 

Guyton, Arthur C., M.D., Medical Physiology, W. B. 
Saunders Co., 1971. 

Knott, David H., M.D., Pli.D, James D Beard, Ph.D., 
Robert D. Fink, M.D., “Acute Withdrawal from Alco- 
hol,” Emergency Medicine, February, 1974. 

Knott, David H., M.D., Ph.D., James D. Beard, Ph.D., 
“The Diagnosis and Therapy of Acute Withdrawal from 
Alcohol,” Current Psychiatric Therapies, Vol. 10, 1970. 

Lesesne, Henry R., M.D., Harold J. Fallon, M.D., “Alco- 
holic Liver Disease,” Post Graduate Medicine, January, 
1973. 

Myerson, Ralph M., M.D., “Metabolic Aspects of Alcohol 
and Their Biological Significance,” Medical Clinics of 
North America, Vol. 57, No. 4. 

West, James W., M.D., “New Program for Alcoholics— 
The Treatment of Alcoholism in a General Hospital,” 
Pacemaker, Little Company of Mary Hospital, Vol. VI, 
No. 1, 1974. 

Yalom, Irving D., The Theory and Practice of Group 
Psychotherapy, Basic Books, Inc., Library of Congress, 
Catalogue No. 7194305, 1970. 


EKG of the Month 

(Continued from page 133) 

ANSWERS: 1. C,.D 2. B,D. The ECG rhythm 
strip shows a supraventricular tachycardia at a 
rate of 215 beats per minute. Note that the last 
R-R cycles prior to cessation of the tachycardia 
lengthen noticeably. This is presumptive evi- 
dence that the electrophysiologic mechanism is 
re-entry or circus movement in the AV node and 
vagal stimulation is making the pathways more 
refractory. This continues until the tachycardia 
breaks. 

In this case the next two beats are probably 
idioventricular escape beats. Sinus rhythm then 
resumes with one remature ventricular beat and 
later pairs of ventricular beats. These all resolved 
to normal sinus rhythm spontaneously. Ventric- 
ular tachycardia would require three rapid ven- 
tricular beats in a row by definition. None of 
this is evidence for a myocardial infarction. This 
myocardial irritability following carotid sinus 
massage is an example of the relatively uncom- 
mon excitatory effects of the vagus. These effects 
are not well understood but may be related to 
acetylcholine (Am. Jrnl. Card. 17:240-252, 1966) . 
Carotid sinus massage as a rule is a safe and diag- 
nostically helpful maneuver. However, these un- 
common effects should be kept in mind. These 
usually resolve spontaneously but a bolus of 
lidocaine may be needed occasionally. ◄ 


136 


Illinois Medical Journal 




Figure 1 Figure 2 Figure 3 


The patient is a 57-year-old male with history of intermittent hematuria of two weeks duration. 
What’s your diagnosis? ( Answer on page 143 ) 


Clinics for Crippled Children Listed for September 


Twenty-eight clinics for Illinois’ physically handicapped 
children have been scheduled for September by the Uni- 
versity of Illinois, Division of Services for Crippled Chil- 
dren. The Division will conduct 22 general clinics provid- 
ing diagnostic orthopedic, pediatric, speech and hearing 
examination along with medical social and nursing ser- 
vices. There will be six special clinics for children with 
cardiac conditions. Any private physician may refer to or 
bring to a convenient clinic any child or children for 
whom he may want examination or consultative services. 

Sept. 4 Hinsdale— Hinsdale Sanitarium 

Sept. 5 Sterling— Sterling Community Hospital 

Sept. 5 Effingham— St. Anthony Memorial Hospital 

Sept. 5 Lake County Cardiac— Victory Memorial Hospital 

Sept. 9 Peoria Cardiac— St. Francis Children’s Hospital 

Sept. 10 Peoria— St. Francis Children’s Hospital 

Sept. 10 East St. Louis — Christian Welfare Hospital 

Sept. 10 Carmi— Carmi Township Hospital 

Sept. 11 Champaign-Urbana— McKinley Hospital 

Sept. 11 Joliet— St. Joseph’s Hospital 

Sept. 12 Springfield— St. John’s Hospital 

Sept. 12 Macomb— McDonough District Hospital 

Sept. 13 Chicago Heights Cardiac— St. James Hospital 

Sept. 17 Belleville— St. Elizabeth's Hospital 

Sept. 17 Rock Island— Moline Public Hospital 

Sept. 17 Decatur— Decatur Memorial Hospital 

Sept. 18 Jacksonville— Norris Hospital 


Sept. 18 Evergreen Park— Little Company of Mary Hos- 
pital 

Sept. 19 Rockford— Rockford Memorial Hospital 
Sept. 19 Elmhurst Cardiac— Memorial Hospital of DuPage 
County 

Sept. 19 Anna— Union County Hospital 

Sept. 23 Peoria Cardiac— St. Francis Children’s Hospital 

Sept. 24 Peoria— St. Francis Children’s Hospital 

Sept. 24 Alton— Alton Memorial Hospital 

Sept. 25 Centralia— St. Mary’s Hospital 

Sept. 25 Chicago Heights— St. James Hospital 

Sept. 25 Elgin— Sherman Hospital 

Sept. 27 Chicago Heights Cardiac— St. James Hospital 

The Division of Services for Crippled Children is the 
official state agency established to provide medical, sur- 
gical, corrective and other services and facilities for diag- 
nosis, hospitalization and after-care for children with 
crippling conditions or who are suffering from conditions 
that may lead to crippling. 

In carrying on its program, the Division works coopera- 
tively with local medical societies, hospitals, the Illinois 
Children’s Hospital-School, civic and fraternal clubs, visit- 
ing nurse association, local social and welfare agencies, 
local chapters of the National Foundation and other in- 
terested groups. In all cases the work of the Division is 
intended to extend and supplement, not supplant activities 
of other agencies, either public or private, state or local, 
carried on in behalf of crippled children. 


for August , 1971 


137 





pulse... of the doctor’s wife 


Mrs. Harold Keegan, Editor 


J 


Chicago 1974 



Delegates and alternates to the Woman’s Auxiliary to 
the American Medical Association who participated at 
the convention held in June in Chicago were first 
row: (left to right) Mrs. Wendell Roller, Mrs. Eugene 
Vickery, Mrs. Thomas Clatter, Mrs. Robert R. Hart- 
man, and Mrs. Edward Szewezyk. 


Back row: Mrs. August Martinucci, Mrs. Joseph 
Shanks, Mrs. Eugene A. Sullivan, Mrs. Eugene J_,eon- 
ard, Mrs. Thomas D. Merink, Mrs. Harlen English, 
Mrs. Harold R. Keegan, Mrs. Howard A. Lowy, Mrs. 
Newton DuPuy and Mrs. John W. Koenig. 


The WA/AMA convention was called to order 
by the President, Mrs. Willard C. Scrivner, East 
St. Lonis. A keynote address was given by Joyce 
Brothers, Ph.D., a well-known columnist, radio 
and television personality. Dr. Brothers directed 
her remarks to the future of the family. 

Other speakers included Birginia Apgar, M.D., 
Ph.D., Senior Vice-President, National Founda- 
tion-March of Dimes; W. Phillip Gramm, Ph.D., 
Professor of Economics, Texas A&M University; 
and Robert Kaplan. Ph.D., Professor and Chair- 
man, Health Education Division, Ohio State 
University. 

Mrs. Howard Liljestrand, of Hawaii was in- 


stalled as National President by Mrs. C. Rodney 
Stoltz, national past president. In her address 
Mrs. Liljestrand stressed health education, alert- 
ness to community needs, increased membership 
and that the county auxiliary is where the ser- 
vice starts. 

Two stars of the convention were our own 
Mrs. Sherman C. Arnold and Mrs. Robert Hart- 
man, Chairman and Vice Chairman, respectively 
of the Committee on Local Arrangements. 

At the dose of the convention, Airs. Willard 
C. Scrivner, immediate WA/AMA Past Presi- 
dent, was welcomed back home. 


138 


Illinois Medical Journal 




Jane Klaren 


Mrs. Ralph F. Davis, our new Vice President of Membership, has been active on the state level 
by serving two terms as Distric 6 Councilor and also as Chairman of Mental Health. In the Adams 
County Auxiliary, Elizabeth has served as President, Chairman of AMA-ERF, Home Centered 
Health Care, Press and Publicity, Program, Membership and Treasurer. 

A former nurse, Elizabeth retired to become a fulltime homemaker. She has three children rang- 
ing in age from 14 to 21 years. Her husband, Ralph, maintains a private practice in radiology in 
Quincy. Amidst her busy schedule, Elizabeth still finds time to be involved in various church, school 
and civic projects. 


Mrs. Edward Szewezyk, Belleville, is a very busy wife, mother and Auxiliary member. Betty and 
Ed, an ophthalmologist, have six children ranging from 8 to 23 years. As a member of the St. Clair 
County Auxiliary she has been active for 19 years and has served as President. Her past experience 
on the state level include Corresponding Secretary, Chairman of WA/SAMA and now Vice-Presi- 
dent of Community Health. 

Prior to her marriage Betty worked as a writer and program director in radio. She recently was 
elected President of the Family Service Agency of Southwestern Illinois. Even with this schedule 
she still has time to be a buyer for a dress shop of which she is part owner. 


Mrs. Earl Klaren, Libertyville, a charter member of the WA/Lake County Medical Society, 
has served on their board since its inception in 1956. At the present time she is Benevolence Chair- 
man. On the state level in addition to her present position as Vice-President of Programs she has 
been Chairman of AMA-ERF for three years. 

fane, the mother of five children and one foster daughter, recently became a grandmother for 
die hrst time. Besides being the wife of a surgeon on the staff at Condell Memorial Hospital, she 
is quite active in her community by serving on school and hospital boards, 4-H leader and work- 
ing with retarded children. 



District Meetings 


September 10 

District 4 

Rock Island 

Place to be announced 

September 17 

District 5 & 6 

Pekin 

Pekin Country Club 

September 19 

District 1 & 2 

Elgin 

Eloliday Inn 

September 27 

District 11 

Joliet 

Place to be announced 


for August, 1974 


139 


Convention ’ 74 



The “Housestaff News” is a neiv feature in the IMJ designed for interns and residents. News 
items and short articles of interest to housestaff will be considered for publication; materials 
should be sent to Michael Hughey, M.D., 711 Laurel Avenue, Wilmette, III. 60091. 


ousestafE physicians from across 
the nation met at Chicago’s Pal- 
mer House for the 123rd annual con- 
vention of the American Medical As- 
sociation in June. These house officers, representing fully 
one-fifth of the nation’s practicing physicians, devoted 
much of their time to discussions of the problems facing 
many of them in their training program as well as the 
problems facing American medicine today. In addition to 
the well-publicized issues of PSRO and national health 
insurance, several issues of primary importance to house- 
staff officers were discussed. 

The report of the Committee on Goals and Priorities 
(GAP) of the National Board of Medical Examiners was 
considered and uniformly condemned by the housestaff in 
attendance. This report, if accepted, would prohibit licen- 
sure of any physician until the completion of all aspects 
of specialty training (see IMJ, May, 1974). Many AMA 
members joined housestaff physicians in condemning cer- 
tain parts of the GAP report. 

The question of due process and fair professional rela- 
tionships between training institutions and house officers 
was raised repeatedly during the convention. In testimony 
before the Interns and Residents Business Session and 
before the Reference Committee on Medical Education, 
several housestaff officers described incidents in their own 
training hospitals which appeared to be flagrant violations 
of the principles of due process. The AMA, which has 
supported the concept of due process for many years, 
listened to these discussions and gave them careful con- 
sideration. From these deliberations and from some ad- 
vance research, a document entitled “Fair, professional 
relationships between training institutions and house 
officers” was developed. The document has been forwarded 
to the AMA Council on Medical Education for study. The 
document outlines the essentials of professional relation- 
ships, noting in particular; the distribution of accurate 
information to prospective applicants, accreditation and 
evaluation, and disciplinary actions (due process). It is 


A Milwaukee Psychiatric Hospital 
A Milwaukee Sanitarium 


hoped that this document will soon become available to 
all housestaff physicians and will be included in the “Es- 
sentials of Approved Residencies.” 

Perhaps the most important housestaff issue discussed 
at the convention was the “Guidelines for Housestaff Con- 
tracts,” a document prepared jointly by the Committee on 
Housestaff Affairs, members of the Board of Trustees of 
the AMA, and the legal council to the AMA. While not 
an actual contract, the document provides information 
lor the development of housestaff contracts and outlines 
many of the issues which may apply to individual training 
institutions. These issues include: 

Obligations of housestaff 

Obligations of the institution 

Salary for housestaff 

Hours of work 

Off-duty activities 

Vacations and leave 

Insurance and professional liability 

Grievance and disciplinary procedures 

Several hours of testimony were heard, both pro and con 
at the Reference Committee on Medical Education. After 
due deliberation, the House of Delegates of the AMA 
directed that the document be given careful study by a 
number of the AMA councils and that the Board of Trus- 
tees issue a final report at the clinical convention at Port- 
land in December. At that time, the final draft of the 
document should be available to all housestaff physicians. 

The growth of housestaff membership in the AMA and 
the participation of housestaff physicians in organized 
medicine in the past few years is unprecedented. The 
many house officers who participated in the Chicago con- 
vention are to be commended for voicing their opinions 
and helping to mold the future of American medicine. 
The thoughts and feelings of participating housestaff 
officers are being heard and considered. Unquestionably, 
these activities are influencing the course of organized 
medicine throughout the country. ◄ 


Intensive, dynamic psychotherapy for adults 

and adolescents, individually planned activity therapy. 


Geriatric program of superior care . . . custodial services 
for persons with chronic emotional illness. 

A Dpwpv Centor i Acute detoxification and inpatient treatment for alcoholic dependency, 
) daily schedules, broad supportive services. 

Units of: MILWAUKEE SANITARIUM FOUNDATION 

1220 DEWEY AVENUE • WAUWATOSA, WIS. 53213 • PHONE (414) 258-2600 

Affiliated with Medical College of Wisconsin 
Accredited by the Joint Commission on Accreditation of Hospitals 
tStan-Profit Non-Sectarian Est. 1884 Participating Member Blue Cross-Blue Shield 



140 


Illinois Medical Journal 


Physician Recruitment Program 


In an effort to reduce the number of towns in Illinois needing physicians, the Physician Recruitment Program and the Doctor’s 
Job Fair, are publishing synopses in the Journal. 

Physicians who are seeking a place to practice or who know of any out-of-state physicians seeking an Illinois residence are 

asked to notify the Program. 

Any areas wishing to be listed should contact: Mrs. E. Duffy, Physician Recruitment Program, ISMS, 360 North Michigan 
Ave., Chicago, 60601. 


ALEDO: Mercer County, 17,000 population, needs addi- 
tional family physicians. 4 active physicians at present. 
General acute hospital in Aledo. High quality medical 
care economically rewarding. Thirty miles from met- 
ropolitan quad-city area. Good small community for 
family living. Contact: Shirley Lindberg or Monty 
McClellan, M.D., 308 NW Fourth Street, Aledo, 61231, 
309/582-5156. (10) 

BLOOMINGTON: General Practitioners, Internists, 
Pediatricians and a Surgeon needed to help establish 
a multi-specialty clinic in a new Erdman Building. 
Corporate practice with all the usual benefits. Contact: 
Paul G. Theobald, M.D., #1 Medical Hills Dr., Bloom- 
ington, 61701, 309/828-6051. (10) 

CHARLESTON: Small midwestern University Health 
Service serving 8,000 students, 4V 2 day week; no after 
hours or weekends. Perfect for post-retirement. Five 
weeks vacation and one week for medical meetings. 
Life insurance, health insurance, and University Re- 
tirement System. Contact: Director, Health Service, 
Eastern Illinois University, Charleston, 61920, (217) 
581-3013. (10) 


CHENOA: Rural area, 100 miles south of Chicago on 
1-55. Looking for one or two physicians to do family 
practice. Hospital facilities nearby. Financial assistance 
and office space can be arranged. Contact: R. J. Walk- 
er, National Bank of Chenoa, Chenoa, 61726, 815-945- 
2311. (10) 


CHICAGO: Board Certified or eligible, Internal Medi- 
cine, Illinois Registration, Medical Center, providing 
preventive and therapeutic medical care with other 
specialists and diagnostic services on premises. Ad- 
ministrative Ability an Asset, Salary Open, Commen- 
surate with background and experience. Call Collect: 
William A. Hutchison, M.D., Union Medical Center, 
1657 West Adams, Chicago, 60612, (312) 829-1134. (10) 

CREVE COEUR: M.D. URGENTLY NEEDED as an 
associate in a very active practice in the Peoria area, 
hospitals. Present M.D. wishes to retire soon and is 
Family or General Practice within six miles of three 
hospitals. Present M.D. wishes to retire soon and is 
concerned with his patients. Financial arrangements 
and over-all needs negotiable. Only those seriously 
interested in private practice call collect 309-699-8022 


or 309-699-5525 or write William Long, M.D., Creve 
Coeur, 111, 60601. (2) 


DEKALB: Northern Illinois University Health Service 
needs Internist; General Practitioner; and Gynecol- 
ogist or practitioner with wide experience in gyne- 
cology and family planning. Reduced paper work, 
better hours, inquiring patients, new health care de- 
livery systems, and University atmosphere provide 
interest. Illinois license required. Equal Opportunity 
Employer. Write L. W. Akers, M.D., Director. NIU 
Health Service, DeKalb 60115. GO) 


FLORA: Population 6,000, Patient-drawing area larger. 
G. P., Internist, Pediatrician. Group or solo. Office 
space can be arranged to suit your needs. Unusually 
well-equipped small hospital with excellent lab and 
X-ray facilities and ICU. Nearby specialty consultants. 
Fine school system and availability of homes. For 
information contact: Administrator, Clay County Hos- 
pital, Flora, 62839, 618-662-2131. (10) 


GENESEO: Family Practice; Ped., Ob-Gyn, Int. Medi- 
cine who will also do General Practice. Population 
7,000 serving area 30,000 on Interstate 80, 2% hrs. 
from Chicago, 25 miles from Quad-Cities metropolitan 
areas, over 300,000. Safe, ideal, small city living, 110 
bed ultra-modern hospital, excellent schools, recrea- 
tional facilities. Hospital has just completed construc- 
tion of two new modern doctor’s offices on hospital 
property which are available immediately. Guarantee 
monthly gross income. Clement G. McNamara, 210 W. 
Elk St., Geneseo, 61254. Call collect (309) 944-6431. (10) 


HARVARD: Population 5,200, estimated trading area 
20,000. Three physicians at present, previously five. 
Center of rapidly growing and financially sound area. 
65 miles northwest of Chicago, 30 miles east of Rock- 
ford. Contact: J. M. Holcomb, Harvard Com. Hosp., 
Grant & McKinley Sts., Harvard, 60033. (10) 


KEOKUK. Expanding Clinic with new offices in prog- 
ressive general hospital offers exceptional opportunity 
to G.P.’s Internists/Cardiologists, General Surgeon 
willing to do some G.P. Guaranteed salary, no invest- 
ment. Group membership one year or less. Surgeon, 
G.P., OB/Gyn, Pediatrician. Ideal environment. Com- 
munity 16,000; service area 50,000. Contact Fred 


for August, 1974 


141 


Shrimpton, Administrator, St. Joseph Hospital, Keokuk, 
Iowa 52632, 319-524-2710. (12) 

LIBERTYVILLE — Thirty-Five miles northwest of Chi- 
cago. Population 12,000 — serving 40,000. Group practice 
of Family Physicians. Affiliated with a 175 bed hospi- 
tal. Corporation benefits. Salary guarantee. Beautiful 
country for lake sports. Contact: Dr. Mark Fields, 716 
S. Milwaukee Rd., Libertyville 60048, 312-362-1390. (10) 

METROPOLIS: Physicians wanted. Complete office 
facilities. Financial assistance available. Modern, well 
equipped hospital serving tri-county area in scenic 
southern Illinois. Contact: Charles Russell, Adminis- 
trator, Massac Memorial Hospital, Metropolis, 62960, 
(618) 524-2176. (10) 


MONMOUTH: Services area population 30,000. Open- 
ing for Family Practice and OB-GYN. Modern well- 
equipped hospital — 141 beds. Near Highways 1-74 & 
1-80. Daily rail to Chicago. Flight service available. 
Safe place to raise family. Near medical school, liberal 
arts college. Contact: Roger E. Gurholt, 1000 W. 
Harlem Ave.. Monmouth, 61462. 309-734-3141. (10) 

PITTSFIELD: Need family practitioners and sur- 
geons interested in locating in rural community area. 
Population 4100; area 18,000. Excellent opportunity 
for someone wanting to practice in a rural community. 
Located between Jacksonville and Quincy, on High- 
way 54 and 36. Contact Dr. T. C. Bunting, Illini 


Community Hospital, Pittsfield 62363. AC 217-285-2141 
or 217-285-2113. (12) 


SAVANNA: Pediatrician, Internist, or General Prac- 
titioner. Illinois community of 5,000 population on 
Mississippi River. 40-bed open staff hospital; excep- 
tional recreational facilities; excellent schools and 
churches of all denominations. Option to practice 
alone or in partnership. Contact: William J. Dayton, 
202 Meadowview Knoll, Savanna, 61074, 815-273-2755. 
( 10 ) 


SHELBY VILLE : Population 6,000 — drawing population 
22,000. New eight man medical ctr. recently opened 
and attached to 100 bed hospital. Object to secure a 
medical practice group. Central location within com- 
muting distane of Springfield — 60 miles, Decatur 35 
miles & St. Louis 115 miles. Located on large lake rec- 
reational area. Contact: John Snyder, Shelby County 
Memorial Hospital, 1st & Cedar Sts., Shelbyville, 62565, 
217-774-3961. (10) 

SPRINGFIELD: Emergency Room Physician, Join 4 
permanent staff physicians at a progressive 580 bed 
general hospital in Central Illinois. Attractive salary 
and benefits. Enjoy the relaxed atmosphere in this 
92,000 population city. Practice medicine without the 
worries of office employees and accounting. Contact 
Arthur Lindsay, M.D. Memorial Medical Center, 1st 
and Miller Streets, Springfield, Illinois 62705. 217-528- 
2041. (12) 


LOW-COST GROUP INSURANCE 
ANOTHER ISMS ! MEMBERSHIP PRIVILEGE 


THE GROUP DISABILITY PLAN • Provides up to $300.00 weekly in the event 
of disability caused by Accident or Sickness. • Special Guaranteed renewal 
feature. • Protect your income and security. 


BUSINESS OVERHEAD EXPENSE PLAN • Pays your office overhead 
expense when disability strikes. • Premiums are Tax Deductible. • Pays in 
Addition to the Disability Plan Benefits. 


THE FAMILY MAJOR MEDICAL EXPENSE PLAN • In or out of Hospital 
Benefits up to $25,000.00 per Disability. • Up to $100.00 Gross Daily Hospital 
Room and Board available. • Subject to choice of deductible and 80% 
coinsurance. 


9933 N. Lawler Avenue 
Skokie, Illinois 60076 
Phone:312-679-1000 


FOR INFORMATION, ASSISTANCE & DETAILS CONTACT: 

Administrators: 



E S T 



eilSHED 19 0 1 

r /?SU/~0/ZCe 


Central Illinois Service Office: 849 Forest Lane — Petersburg, III. 62675 • phone 217-632-7220 

Wayne J. Hubbert, District Manager 



Obituaries 


“Apfellach, George L., Chicago, died June 19 at the 
age of 89. He graduated from Northwestern University 
in 1910. 

“Bina, Francis, Belleville, died February 17 at the age 
of 55. Dr. Bina graduated from the Chicago Medical 
School in 1947. 

“Collins, John J. Chicago, died June 10 at the age of 

74. He was a graduate of Loyola Stritch School of 
Medicine. 

“Crispin, Samuel G., Danville, died June 17 at the age 
of 89. He graduated from Loyola Medical School in 
1922. 

“Doescher, Paul F., Chicago, died June 17 at the age of 

75. He was a graduate of Northwestern University in 
1926. Dr. Doescher was a staff member of Garfield Park 
Hospital for 50 years. 

‘“Edison, Arthur I., Chicago, died June 20 at the age of 
87. Dr. Edison graduated from the Chicago College of 
Medicine and Surgery in 1914. 

“Head, Jerome Reed, Evanston, died June 11 at the age 
of 81. Dr. Head graduated from the Harvard Medical 
School, Boston, in 1922. He was associate professor 
emeritus of Surgery at Northwestern Memorial Hospital 
and a founder and member of the American Board of 
Thoracic Surgery. Dr. Head was also a past president of 
the Board of the Suburban Cook County Tuberculosis 
District. 

“Krauss, Thomas F., Rockford, died June 20 at the age 
of 82. He graduated from Rush Medical College in 1922. 

“Larson, Myron W., Aurora, died June 9 at the age of 
63. He graduated from Illinois University in 1937. 

“Meyer, George E., Belleville, died April 1973 at the age 
of 69. He graduated from the Washington University, 
St. Louis, in 1930. 

“Richards, Charles S., Rockford, died Jan. 13 at the age 
of 39. Dr. Richards graduated from Downstate Medical 
College, Brooklyn, New York, in 1962. 

“Shapiro, Sherman L., Chicago, died May 29 at the age 
of 79. He graduated from the University of Illinois in 
1925. Dr. Shapiro also was a past president of the Chi- 
cago Laryngological and Otological Society. 

“Sheehe, Norman L., Rockford, died at the age of 82. 
He graduated from the Albany Medical College in 1917. 

“Sokoloff, Anna, Chicago, died June 6 at the age of 80. 
She graduated from Loyola Stritch School of Medicine 
in 1918. 

* Denotes member of ISMS 
c<t Denotes member of 50-Year Club of ISMS 


View Box 

(Continued from page 137) 

DIAGNOSIS: Hypernephroma of the upper pole 
of the left kidney. In Figure 1 (nephrotomogram) 
an abnormal hump is demonstrated on the 
medial aspect of the upper pole. Figure 2 (a se- 
lective left renal arteriogram) suggests some ab- 
normal vascularity in the left upper jmle. Figure 
3 represents a study after the administration of 
12 u.g. of epinephrine into the renal artery 
catheter. This caused a decreased flow through 
the vessels supplying normal parenchyma. The 
tumor vessels however, are densly opacified. Ex- 
perience indicates that epinephrine angiography 
is of major usefulness in enhancing the cpiality of 
demonstration of renal carcinoma. The most ac- 
cepted theory is the presence of elastic fibers 
causes a marked vaso constriction in normal cir- 
culation, but their absence in tumor vessels re- 
sults in a marked increase in vascularity in the 
region of the tumor. 

Reference 

Kahn, P. C., The Epinephrine Effect in Selective Renal 
Angiography, Radiology, 85:301, 1965. 


In Favor Of Sports 

The fundamental plinth on which our policy rests is 
the assumption that sport is a natural, worth while, and 
enjoyable form of human expression and eminently de- 
serves support in its own right and for its own sake. I 
would not like to try to imagine a world in which there 
were no games to play, no chance to satisfy the natural 
human impulses to run, to jump, to throw, to swim, to 
dance. The Arts Council, the proponents of music, paint- 
ing, and literature, do not seek to justify these things by 
pointing to some superior good. They regard music and 
painting as in themselves eminently worth while and de- 
sirable. And this, I suggest, is how we should look on 
physical recreation. 

The historic Physical Training and Recreation Act 1937 
originated from a British Medical Association report on 
the declining fitness of the population. As one reads the 
Commons’ debate on this Bill it is like passing through a 
desert and suddenly stumbling on an oasis to come on 
Aneurin Bevan's blunt and pithy answer to those whose 
support of the Bill was in terms of its beneficial side 
effects: “. . . the desire to play is a justification in itself 
for playing.” “Compulsory enjoyment comes near to being 
a contradiction in terms,” the Wolfenden report remarked. 
We do, however, want to inspire everyone to wish to take 
part by making the choice irresistible in its scope and 
variety. The whole focus of our policy is on providing 
opportunities for participation and, above all, opportuni- 
ties for all. (Roger Bannister: Sport, Physical Recreation, 
and the National Health. Brit. Med. Journal (Dec 23) 
1973, pgs. 711-715.). 


for August, 1974 


143 


CLASSIFIED ADVERTISING 


Positions & Practice Opportunities 


IMMEDIATE FAMILY PRACTICE OPENING— in two man clinic. Liberty- 
ville, Illinois, 35 miles northwest of Chicago. Initial salary and early 
partnership. Busy practice in small suburban town. Call collect— 
Dr. Lawrence C. Day (312) 362-144 7. 


ATTENTION PHYSICIANS! CHICAGO MEDICAL CENTERS-Welfare 
area in need of physicians. Please contact: Mr. Robert Fields (312) 

236-2555. 


GENERAL INTERNISTS and GENERALISTS: For growing sub-sections 
of 45 man medical department, including allergists, psychiatrists, 
neurologists, all sub-specialties and expanding primary care section. 
Multispecialty group of 120. Large patient population and area re- 
ferral. Functioning HMO. Generous salary and fringe benefits. Peace- 
ful setting near Wisconsin vacationland and cities. Good schools, 
cultural advantages. Junior College. Educational and research pro- 
grams. Liberal schedules, little practice pressure. New Clinic and 
hospital developing. Write or call J. L. Struthers, M.D., Marshfield 
Clinic, Marshfield, Wisconsin 54449. 


Immediate opening for Ob-Gyn and Internal Medicine, specialties 
to establish successful practice with 14-man multi-specialty group. 
Excellent group benefits; pension plan; modern clinic facilities; 
progressive community with excellent educational system includ- 
ing two colleges; city population 35,000; good recreational facilities; 
each specialty must be board eligible or certified. Contact: Business 
Manager, The Manitowoc Clinic, 601 Reed Avenue, Manitowoc, Wis- 
consin 54220. 


PRACTICE and OFFICE AVAILABLE, about August 1, 1974, in a 
growing central Illinois town. Size 10,000, local hospital 75 beds, 
and 6 area nursing homes. Principally GP, OB, Geriatrics & in- 
dustrial practice. Price Negotiable. Present location 35 years. In- 
come $50,000-75,000. Reason for moving, health and age. Write: 
Box 831, c/o Illinois Medical Journal, 360 N. Michigan Ave., 
Chicago, IL 60601. 


Well-established, prosperous North-Michigan Avenue, Chicago In- 
ternist practice available because of sudden death. Sub-specialties 
in Electrical Cardiography and Allergy. Especially able and loyal 
staff and equipment also available. Financial information and further 
detail furnished promptly to interested parties. Contact Richard W. 
Burke, Attorney, 3220 Prudential Plaza, Chicago, Illinois 60601, (312) 
944-2400. 


MEDICAL DIRECTOR for permanent, fulltime position with a neigh- 
borhood health center at the University of Illinois Hospital and Medi- 
cal School. Academic appointment, excellent salary and fringe bene- 
fits. Opportunity for innovative medical care research in systems and 
manpower. Student and community education programs. Work with 
inner city population adjacent to the Medical Center complex. ILLI- 
NOIS LICENSE REQUIRED. Available now. Salary, rank open. Con- 
tact Edward A. Lichter, M.D., Prof. & Head, Dept. Prev. Med. & 
Commu. Hlth., P.O. Box 6998, Chicago, III. 60680. Phone, 312-996- 
7630. The University of Illinois is an Affirmative Action-Equal Op- 
portunity Employer and encourages applications from members of 
minority groups and women. 


Full Time Physician for Outpatient Department of Prepaid Health 
Plan. Five day 40-hr. week. No on call. Located in Central Illinois. 
New modern facility. Salary open. Tax shelter available. Contact 
administrator, Wabash Memorial Hospital Assn., 360 E. Grand, Decatur, 
III. 62525. Telephone: (217) 429-5246. 


GENERALIST for full time position in university health service; 40-hr. 
week, no on-call responsibilities; excellent community of 75,000, 
three local hospitals. Salary negotiable with liberal fringe benefits 
including 30-day vacation and retirement plan. Illinois license. Write 
or call: Margaret M. Torrey, M.D., Illinois State University, Normal, 
Illinois 61761. Phone (309) 438-8655. 


WHY FIGHT PSRO's, HMO's, AND ILLINOIS PUBLIC AID? Join us- 
minimal records, short hours, 5 weeks vacation, and 1 week medical 
meetings. Illinois University Retirement System, Health Insurance, 
and Life Insurance. Beginning salary $25,000 and negotiable. Call 
or contact Director, Health Service, EIU, Charleston, Illinois. Phone 
217-581-3013. 


FAMILY PRACTICE AVAILABLE about Sept. 1, 1974. Excellent set 
up with high earnings. Western suburb of Chicago. Write to Box 
834 c/o Illinois Medical Journal, 360 N. Michigan, Chicago, Illinois, 
60601. 


Positions & Practice Opportunities (Can’t) 


EXPERIENCED, BUSY G. P. seeking regular hours. Will consider a 
clinic, hospital E. R. or other. Write Box 833 c/o Illinois Medical 
Journal, 630 N. Michigan, Chicago, Illinois 60601. 


CASHMERE, WASHINGTON FAMILY PRACTICE opportunity in two- 
man office with four doctor week-end rotation. Scenic setting in 
orcharding valley on east edge of Cascades. Choice mountain and 
lake recreation and skiing. Vital community with quality schools. 
Excellent hospital facilities and cultural advantages in nearby 
Wenatchee. E. A. Meyer, M.D. (Iowa '50) ABFP, 303 Cottage 
Avenue, Cashmere, Wash. 98815. Tel.: (509) 782-1541. 


EMERGENCY ROOM PHYSICI AN-Need fifth man to join four full- 
time physicians interested in acute care medicine. Regular hours, 
excellent fringe benefits, salary negotiable. 410-bed hospital (com- 
munity). Medical School affiliation. ER group incorporation under 
consideration. Contact: John Edmundson, V-P Administration, Rock- 
ford Memorial Hospital, 240 North Rockton Avenue, Rockford, 
Illinois 61101. 


FAMILY PRACTICE: Replacement for one year while I take a sab- 
batical. Net earnings are yours. This is an excellent community 
to live in. Lovely office in Professional Building. If you want to 
practice Medicine look this over. Down state Illinois. Write to: 
Box 835. Illinois Medical Journal, 360 N. Michigan Ave., Chicago, 
Illinois 60601. 


FAMILY PHYSICI ANS—U nique practice opportunity in an incor- 
porated 28 man group in east central Wisconsin. New clinic 
facility across the street from 450 bed hospital. Ideal cultural and 
recreational setting. Opportunity to develop special interests in 
acute and ongoing adult care and/or industrial medicine. Equal 
stockholder in one year. Excellent pre-tax fringes. Write Box 836. 
Illinois Medical Journal, 360 N. Michigan, Chicago, III. 60601. 


Large physician group has immediate positions available for full- 
time or part-time Clinic and Emergency Room work. Several loca- 
tions in Chicago and Central Illinois. Salary plus liberal benefits 
average over $20.00 per hour for full-time work. Scheduling flexible 
to meet individual needs. Contact Gene Gaertner, M.D., 153 W. 
Lake, Bloomingdale, III. 312-627-3404. 


ASSISTANT MEDICAL DIRECTOR — Nation's seventh largest life in- 
surance company is adding to its staff of eight physicians doing 
medical underwriting. We offer a generous fringe benefits and 
retirement package, four weeks paid vacation, and 37V2 hour work 
week. If interested, please write or call (collect) Jack A. End, M.D., 
Medical Director, Northwestern Mutual Life Insurance Company, 
720 East Wisconsin Avenue, Milwaukee, Wl 53202. (414) 271-1444. 


FAMILY PRACTITIONERS AND INTERNSTS Full time salaried ap- 
pointment to Medical Staff at Cook County Hospital with op- 
portunity to practice half time or more in a community clinic. 
Write or call David Me L. Greeley, M.D. Health and Hospital Govern- 
ing Commission, 1900 West Polk Street, Chicago, Illinois 60612. 
Telephone: 633-8825. 


Full Time Medical Officers Major Chicago— area hospital has im- 
mediate opening for General Practioners and other specialists; 
Joint Commission accredited Medical Center; attractive benefits; 
competitive salary; all shifts available (8-4; 4-12; 12-8); Medical 

coverage needed for acute care, rehabilitation, skilled nursing and 
intermediate care levels; Excellent opportunity for professional 
advancement. Send curriculum vitae to: Ms. T. Higgins, Personnel 
Manager, Oak Forest Hospital, 15900 South Cicero Avenue, Oak 
Forest, Illinois 60452. 


Applications are invited from board certified pediatricians in- 
terested in a full time position in Ambulatory Pediatrics at Cook 
County Hospital. Position will involve responsibilities for teach- 
ing pediatrics, house staff and medical students, providing direct 
patient care to groups of families in both the Acute Care and 
Comprehensive Care Units and participation in research projects 
which are in process or may be originated. Illinois license is 
required, contact: Agnes Lattimer, M.D., Chairman, Division of 

Ambulatory Pediatrics, Department of Pediatrics, Cook County Hos- 
pital, 1825 West Harrison Street, Chicago, Illinois 60612. 


144 


Illinois Medical Journal 


BLUE SHIELD 




d) 


dY r\ } 


Jv\ 



J\aU 




FOR 




Utilization and Completion of the Revised Physician's Service Report 


Since the Blue Shield Physician’s Service Report 
form was revised and new supplies distributed in 
May, we have been interested in your response to 
revisions in the Service Report and whether any of 
the changes were causing problems in completing 
the form. 

To gather a number of meaningful statistics, we 
asked our Blue Shield Claims Department to ana- 
lyze a sampling of claims received the past month. 
The audit showed the following results: 

• Of the 6,000 claims received daily, nearly 40 
percent were submitted on the out-dated Physician’s 
Service Report form. While this will not delay a 
claim, the revised Service Report should be utilized. 
It was designed for our new processing equipment 
now in operation and its use also involves employee 
training and orientation in the implementation of 
the new system. 

• Nearly 15 percent of the total claims received 
are delayed because of errors and omission in com- 
pleting the forms. Relatively high proportions of 
the errors and omissions are occuring in the top 
portion of the new form. Most involve incorrect 
Group Numbers and Member Identification Num- 
bers. If these numbers are entered incorrectly, our 
computer is unable to validate a member’s eligibil- 
ity for benefits. Most delays begin here. 

The most reliable source for membership iden- 
tification is the patient’s Blue Shield Identification 
Card. Copy the Group and Member ID numbers 
exactly as they are shown on the card. Please do 
not include the codes. 

• The rectangular box to the right, on the first 
line of the claim form, is reserved for a patient’s 
account number given in a physician’s office or 


clinic. It is not intended for membership identifica- 
tion purposes. 

• Patient and member names are often spelled 
incorrectly, transposed on the lines, or the address 
may be incomplete. 

• Information on sex, age, married or single 
status and patient’s relationship to member must 
be completed. Any one of these data entries, if 
omitted, will delay a claim. 

• Data on “If Accident/Medical Emergency, 
Give Date:” This information is often omitted, as 
well as where the accident or medical emergency 
happened. It must be entered on the claim form. 

The above items, because of their importance 
initially in completing a claim, are circled or under- 
scored in the portion of the Service Report repro- 
duced below. 

Other data that is frequently incomplete in- 
cludes: 

(1) The diagnosis: Give significant descriptions. 
Please use standard medical nomenclature in sur- 
gical procedures if an operation is performed. 

(2) Itemize each service and show total fee for 
described service. Also indicate whether or not 
fee has been paid by the patient. This informa- 
tion is especially important so that payment can 
be made to the physician on the basis of the Usual 
charges for Blue Shield members protected by our 
Usual and Customary programs; 

(3) If other physicians have also rendered ser- 
vices each must submit his own Physician’s Service 
Report. Please do not use the imprinted Service 
Report of another physician; 

(4) Signature of the physician rendering the ser- 
vice must be on the Physician’s Service Report. 


f PHYSICIAN'S SERVICE REPORT 

Blue Shield Plan of Illinois Medical Service 
233 North Michigan Avenue, Chicago, Illinois 60601 • 

Group No. & Member ID No._ 

Patient's Name MARY JONE 
Member's Name JOHN JONES 



661-4200 


Patient's Account Number 


Sex F Age 42 fxl Married □s ingle 


Patient's Relationship to Member: 1 QSelf. 2 |x] Spouse. 3| | Dependent. 


and Address 20 EAST 7th STREET - CHICAGO, ILLINOIS 60610 

If Accident/Medical Emergency, Give Date: 7-15-74 Happened at: id Home 2d Work 3® Auto 4d Other: 


(This report is a service to the physicians of Illinois) 


ASK BLUE SHIELD 

. . . ABOUT MEDICARE 

Optional Payment Method for Patients on Maintenance Dialysis; 
Monthly Payment for Self-Dialysis Patients 


Part II of the Summary 

The new instructions on renal dialysis treat- 
ment and payment options issued to Tart A 
intermediaries and Part B Medicare carriers are 
published at the request of the Department of 
Health, Education and Welfare. 

Part I of the instructions was published in 
the August issue of “Ask Blue Shield About 
Medicare” and included a discussion of the 
alternative payment method, the flat fee for self 
dialysis training, and services covered. The sum- 
maries are intended as information on the pro- 
gram to the general medical community. Spe- 
cific details on the instructions and revisions 
may be obtained from the intermediary or car- 
rier in your service area (Blue Shield for Part B 
in Cook County). 


Services Not Covered 

(1) Declotting of shunts. 

(2) Physician services to inpatients. The monthly 
fee is reduced by 1/30 for each day of hospitaliza- 
tion, and the physician may bill on a fee-for-service 
basis. When inpatient services are furnished, the 
period between the date of the last outpatient 
facility dialysis and the next routine facility dialysis 
is used as the period for which services are sub- 
tracted from the monthly billing. If the physician 
wishes to continue receiving the full monthly pay- 
ment instead of billing on a fee-for-service basis 
he may do so, but not bill on an individual basis. 

(3) If a patient is dialyzed in an outpatient 
facility other than his usual facility, and the fa- 
cility includes charges for “supervisory” services, 
payment to the attending physician is reduced the 
appropriate number of days. 

(4) Services for an unrelated illness either by 
the physician providing renal care or another 
physician may be billed on a fee-for-service basis. 
The physician must provide documentation that 
the disease is not related to the renal condition 
and that added visits were required. 

(5) Services rendered by other physicians for 
concurrent care are not covered on the monthly 
payment basis. The Medicare program permits re- 
imbursement for services on a separate claim, 
furnished by a second physician in addition to 
the attending physician if the services meet the 
definition of consultative services and are deter- 
mined by the carrier as reasonable and necessary 
to assist the attending physician in assessing or 
treating the patient’s total medical condition. 

Another involving services that would be covered 
separately occurs when the services of two or more 
physicians are required for an active role in the 
patient’s treatment because of the presence of 
more than one medical condition requiring diverse 


specialized medical services. All claims involving 
such concurrent care are reviewed by the carrier 
to determine whether the services are reasonable 
and necessary. 

Conditions for Election of Optional Method 

( 1 ) Physicians at a facility are free to decide 
whether they will bill for physicians services to 
patients under either the current method or month- 
ly payment method. However, all physicians at- 
tending patients within a given facility may use 
only one method and must agree to bill under only 
one method. 

When physicians form a team to provide the 
monthly continuity of services to a group of pa- 
tients, one monthly payment would be made for 
each patient in the group’s care. 

(2) In facilities where reimbursement is under 
the current method and physicians elect the 
monthly method, administrative charges are re- 
duced accordingly. 

(3) When a patient is temporarily attended by 
another physician, it is the responsibility of the 
primary care physician to share reimbursement. 
As in the case of an associate attending the patient, 
the patient cannot be billed twice. If one physician 
covers for another no modification in reimburse- 
ment is involved. If reimbursement must be shared, 
the physicians make the appropriate arrangement. 

II. Monthly Payments to Patients on Self-Dialysis 
at Home or in a Facility 

The same method for determning the amount 
of payment is used except the conversion factor 
is 14, rather than 20. The amount of the factor 
is less because self-dialysis patients generally do 
not require as extensive services as patients in 
facilities who are not on self-dialysis. 

Services covered are: 

( 1 ) Those furnished during a dialysis session, 
including back-up dialysis in outpatient facilities; 

(2) Office visits for the routine evaluation of 
patient progress, including interpretations of diag- 
nostic tests and procedures; 

(3) Those furnished by the attending physician 
in the course of office visits, the primary purpose 
for which is the monitoring or follow-up of com- 
plications of dialysis, including services involved 
in prescribing therapy without increasing the num- 
ber of contacts beyond those occuring at normal 
monitoring sessions or visits for treatment of renal 
complications, 

(4) General support services (arranging for 
supplies, etc. ) 

Services not covered are the same as those 
applying to patients on maintenance dialysis de- 
scribed above. 


(This report is a service to the physicians of Illinois) 



Illinois Medical Journal 


SEPTEMBER, 1974 Vol. 146, No. 3 


Special Articles 


175 Abstracts of the Board of Trustees Action 

197 Report on Legislation 

208 October Is Immunization Action Month 

Joyce C. Lashof, M.D. 


CONTENTS 


Clinical Articles 


177 

180 


Personal History of Paget’s Disease 

Osteitis Deformans with Several Unusual Features and Their Control 
Reuben Bard, M.D. 

The Bleeding Duodenal Ulcer 

James Hines, M.D., Larry Wilkholm, M.D. 


185 Primary Ovarian Pregnancy 

William Vulgaris, M.D., and Walter Reich, M.D. 

189 Rehabilitation of the Patient with Chronic Low Back Pain 

Aaron M. Rosenthal, M.D. 


Surgical Grand Rounds 

205 Renal Tumor 

John M. Beal, M.D. Editor 


History of Medicine 

215 Edmund Andrews— The Forgotten Pioneer of Chicago Urology 

Joseph H. Keifer, M.D. 


President’s Page 

169 Federal PSRO vs Illinois Alternatives 

Fredric D. Lake, M.D. 


for September, 1974 


151 


CONTENTS (continued) 


Features 

162 Clinics For Crippled Children 

191 EKG of the Month 

192 Membership Forum 

196 Housestaff News 

199 Doctor’s News 

201 Editorial 

213 ISMS Guide to Continuing Medical 

Education 

220 Pulse of the Doctor’s Wife 

225 Illinois Society, American Association 

of Medical Assistants 
227 Physician Recruitment 

229 Obituaries 

230 Classified Advertising 


Staff 

Editor Theodore R. Van Dellen, M.D. 

Managing editor Richard A. Ott 

Assistant editor Joyce Gallagher 

Executive administrator Roger N. White 

(Cover by Alicia Kolton) 

PUBLICATIONS COMMITTEE 

Jacob E. Reisch, M.D., Springfield, Chairman 
Eugene T. Hoban, M.D., Oak Park 
A. Edward Livingston, M.D., Bloomington 
James A. McDonald, M.D., Geneva 
Warren W. Young, M.D., Crete 


Contributor in Surgery: John M. Beal, M.D., Chicago 
Contributor in Medical Progress: Harvey Kravitz, M.D., Skokie 
Contributor in Maternal Death Studies: 

Robert Hartman, M.D., Jacksonville 
Contributor in Pediatric Perplexities: Ruth A. Seeler, M.D., Chicago 
Contributor in Radiology: Leon Love, M.D., Maywood 
Contributor in Cardiology: John R. Tobin, M.D., Maywood 


ILLINOIS STATE 
MEDICAL SOCIETY 
360 N. Michigan Ave., Chicago, 60601 

OFFICERS 

Fredric D. Lake, M.D., President 
1041 Michigan Ave., Evanston 60202 
J. M. Ingalls, M.D., President-Elect 
502 Shaw, Paris 61944 
Harold A. Sofield, M.D., 1st Vice-President 
715 Lake Street, Oak Park 60301 
Robert Hartman, M.D., 2nd Vice-President 
1515A W. Walnut Street, Jacksonville 62650 
Jacob E. Reisch, M.D., Secretary-Treasurer 
1129 S. 2nd St., Springfield 62704 

HOUSE OF DELEGATES 

Andrew J. Brislen, M.D., Speaker of the House 
6060 S. Drexel Blvd., Chicago 60637 
James A. McDonald, M.D., Vice-Speaker 
13 S. 2nd St., Geneva 60134 

TRUSTEES 

1st District: 1977, Joseph L. Bordenave, M.D. 

1665 South Street, Geneva 60134 
2nd District: 1977, Allan L. Goslin, M.D. 
712 N. Bloomington, Streator 61364 
3rd District: 1976, David S. Fox, M.D. 
20829 Greenwood Center Ct., Olympia Fields 60461 
3rd District: 1976, Robert T. Fox, M.D. 
2136 Robin Crest, Glenview 60025 
3rd District: 1975, Eugene T. Hoban, M.D. 

6429 North Ave., Oak Park 60302 
3rd District: 1975, Joseph Skom, M.D. 
707 Fairbanks Ct., Chicago 60611 
3rd District: 1977, William M. Lees, M.D. 
6518 North Nokomis, Lincolnwood 60646 
3rd District: 1977, George Shropshear, M.D. 

1525 E. 53rd St., Chicago 60615 
3rd District: 1977, Philip G. Thomsen, M.D. 

13826 Lincoln Ave., Dolton 60419 
3rd District: 1976, Frederick E. Weiss, M.D. 

15643 Lincoln, Harvey 60426 
3rd District: 1975, Warren Young, M.D. 

3450 Haweswood Dr., Crete 60417 
4th District: 1976, Fred Z. White, M.D. 
723 N. 2nd St., Chillicothe 61523 
5th District: 1976, A. Edward Livingston, M.D. 

326 Fairway Dr., Bloomington 61701 
6th District: 1975, Mather Pfeiffenberger, M.D. 

State and Wall Sts., Alton 62002 
7th District: 1976, Arthur F. Goodyear, M.D. 

142 E. Prairie, Decatur 62523 
8th District: 1976, Eugene P. Johnson, M.D. 

P.O. Box 68, Casey 62420 
9th District: 1975, Warren D. Tuttle, M.D. 

203 N. Vine St., Harrisburg 62946 
10th District: 1975, Herbert Dexheimer, M.D. 

301 S. Illinois, Belleville 62220 
11th District: 1977, Ross Hutchison, M.D. 
126 E. Ninth St., Gibson City 60936 
Trustee-At-Large: Willard C. Scrivner, M.D. 

6600 West Main, Belleville 62223 
Chairman of the Board: Joseph L. Bordenave, M.D. 

1665 South Street, Geneva 60134 


Microfilm copies of current 
as well as some back issues 
of the Illinois Medical Jour- 
nal may be purchased from 
Xerox University Microfilm, 
300 North Zeeb Road, Ann 
Arbor, Mich. 48106. 



Contents of IMJ are listed in the Current Contents/ Clinical Practice. 

Published by the Illinois State Medical Society, 360 N. Michigan Ave., Chicago, 111. 60601 (312-782-1654) 
Copyright, 1974. The Illinois State Medical Society. 

Subscription $8.00 per year, in advance, postage prepaid, for the United States, Cuba, Puerto Rico, 
Philippine Islands and Mexico. $10.00 per year for all foreign countries included in the Universal Postal 
Union. Canada $8.50. U.S. Single current copies available at $1.00 ($1.10 by mail), back issues $1.50. 

Second class postage paid at Chicago, 111. When moving please notify Journal office of new address 
including old mailing label with notification, if possible. POSTMASTER: Send notice on form No. 3579 to 
Illinois State Medical Society, 360 N. Michigan Ave., Chicago, 111. 60601. 

Pharmaceutical advertising must be approved by the ISMS Publications Committee. Other advertising 
accepted after review by Publications Committee or Board of Trustees. All copy or plates must reach the 
Journal office by the fifteenth of the month preceding publication. Rates furnished upon request. 

Original articles will be considered for publication with the understanding that they are contributed only 
to the Illinois Medical Journal. The ISMS denies responsibility for opinions and statements expressed by 
authors or in excerpts, other than editorial or allied views or statements which reflect the authoritative action 
of the ISMS or of reports on official actions, policies or positions. Views expressed by authors do not 
necessarily represent those of the Society; any connection with official policies is coincidental. 



In the treatment of i 
with congestive heart h 


To counteract 
Na + reabsorption 
and excessive 
K + excretion 




to thiazides and rurosemide 


risk of digitalis 
je to potassium depletion, 

the myocardium 
fects of digitalis, and 


>tropic effect. 




literature or PDR. The following is a brief s 

Edema associated with congests 
ephrotic syndrome; steroid-induced edema, i 
condary hyperaldosteronism and edema i 
ntraindlcations: Severe or progressive kid 
Jssible exception: nephrosis). Severe hepatic < 
levated serum potassium. Hypersensitivity to th 
eveloping hyperkalemia. Do not give | 
or by diet. 

rnings: Observe regularly for possible blood 
her idiosyncratic reactions. Blood dyscrasia- 
UN and serum potassium peric " *" 

-d those with suspected or confirmed renal insu 
ly when essential to patient welf; 
lium (triamterene, SKaF) an 
ly ; if they are, he 


Precautions: If hyperkalemia develops, withdraw the drug. The follow- 
ing may also occur: electrolyte imbalance, low-salt syndrome (with low 
t intake), reversible mild nitrogen retention, decreasing alkali reserve with 
possible metabolic acidosis. Do periodic hematoJogic studies in cirrhotics 
I with splenomegaly. Concomitant use with antihypertensive drugs may result 
in an additive hypotensive effect. When Dyrenium' is to be discontinued 
after intensive or prolonged therapy, withdraw gradually because of possible 
rebound kaliuresis. 

Adverse Reactions: Diarrhea, nausea and vomiting (may indicate electrolyte 
imbalance), other gastrointestinal disturbances, weakness, headache, dry 

SSEXSl " | 


th, anaphylaxis, photosensitivity, elevated uric acid, rash. 

Note: When combined with another diuretic, the initial dosage of each agent 
should be lower than recommended 


Supplied: 100 mg. capsules in bottles and Single Unit Packages of 


auired. 


rtions 


SK&FCO. 

Subsidiary of Smith Kline Corporation 








100 






Clinics for Crippled Children 
Listed for October 

Thirty three clinics for Illinois’ physically handicapped 
children have been scheduled for October by the Uni- 
versity of Illinois, Division of Services for Crippled Chil- 
dren. The Division will conduct 23 general clinics pro- 
viding diagnostic orthopedic, pediatric, speech and hearing 
examination along with medical social and nursing ser- 
vices. There will be seven special clinics for children with 
cardiac conditions, and three for children with cerebral 
palsy. Any private physician may refer to or bring to a 
convenient clinic any child or children for whom he may 
want examination or considtative services. 

Springfield Pediatric-Neurology— Diocesan 
Center 

Metropolis— Massac Memorial Hospital 
Rock Island Cerebral Palsy— Foundation for 
Crippled Children and Adults 
Hinsdale— Hinsdale Sanitarium 
Sterling— Sterling Community Hospital 
Flora— Clay County Hospital 
Lake County Cardiac— Victory Memorial Hos- 
pital 

Cairo— Public Health Department 
Chicago Heights Cardiac— St. James Hospital 
Peoria— St. Francis Children’s Hospital 
Carrollton— Boyd Memorial Hospital 
East St. Louis— Christian Welfare Hospital 
Champaign-Urbana— McKinley Hospital 
Rockford— St. Anthony Hospital 
Springfield— St. John’s Hospital 
Kankakee— St. Mary’s Hospital 
Chicago Heights Cardiac— St. James Hospital 
Peoria Cardiac— St. Francis Children’s Hos- 
pital 

Quincy— St. Mary’s Hospital 
Rock Island— Moline Public Hospital 
Chicago Heights— St. James Hospital 
Bloomington— Mennonite Hospital 
Elmhurst Cardiac— Memorial Hospital of Du- 
Page County 

Peoria— St. Francis Children’s Hospital 
Danville— Lake View Hospital 
Centralia— St. Mary’s Hospital 
Chicago Heights Cardiac— St. James Hospital 
Evanston— St. Francis Hospital 
Peoria Cardiac— St. Francis Children’s Hos- 
pital 

East St. Louis— Christian Welfare Hospital 
Mt. Vernon— Good Samaritan Hospital 
Springfield Pediatric Neurology— Diocesan 

Center 

Aurora— St. Joseph Mercy Hospital 
Division of Services for Crippled Children is the 
state agency established to provide medical, sur- 
gical, corrective and other services and facilities for diag- 
nosis, hospitalization and after-care for children with 
crippling conditions or who are suffering from conditions 
that may lead to crippling. 

In carrying on its program, the Division works coopera- 
tively with local medical societies, hospitals, the Illinois 
Children’s Hospital-School, civic and fraternal clubs, 
visiting nurse association, local social and welfare agen- 
cies, local chapters of the National Foundation and other 
interested groups. In all cases the work of the Division is 
intended to extend and supplement, not supplant activities 
of other agencies, either public or private, state or local, 
carried on in behalf of crippled children. 


October 

2 

October 

2 

October 

2 

October 

2 

October 

3 

October 

3 

October 

3 

October 

3 

October 

4 

October 

8 

October 

8 

October 

8 

October 

9 

October 

10 

October 

10 

October 

10 

October 

11 

October 

14 

October 

15 

October 

15 

October 

16 

October 

17 

October 

17 

October 

22 

October 

22 

October 

23 

October 

25 

October 

25 

October 

28 

October 

29 

October 

29 

October 

30 

October 

30 

The Divis 

official state 


PROLOID® (thyroglobulin) 

Caution: Federal law prohibits dispensing without 
prescription. 

Description. Proloid (thyroglobulin) is obtained 
from a purified extract of frozen hog thyroid. 
It contains the known calorigenically active 
components, Sodium Levothyroxine (T4) and 
Sodium Liothyronine ( T 3 ) . Proloid (thyroglobu- 
lin) conforms to the primary USP specifications 
for desiccated thyroid— for iodine based on 
chemical assay— and is also biologically as- 
sayed and standardized in animals. 

Chromatographic analysis to standardize the 
Sodium Levothyroxine and Sodium Liothyro- 
nine content of Proloid (thyroglobulin) is rou- 
tinely employed. 

The ratio of T 4 and T 3 in Proloid (thyroglob- 
ulin is approximately 2.5 to 1 . 

Proloid (thyroglobulin) is stable when stored 
at usual room temperature. 

Indications. Proloid (thyroglobulin) is thyroid 
replacement therapy for conditions of inade- 
quate endogenous thyroid production: e g , 
cretinism and myxedema. Replacement therapy 
will be effective only in manifestations of hypo- 
thyroidism. 

In simple (nontoxic) goiter, Proloid (thyro- 
globulin) may be tried therapeutically, in non- 
emergency situations, in an attempt to reduce 
the size of such goiters. 

Contraindication. Thyroid preparations are 
contraindicated in the presence of uncorrected 
adrenal insufficiency. 

Warnings. Thyroglobulin should not be used 
in the presence of cardiovascular disease un- 
less thyroid-replacement therapy is clearly in- 
dicated. If the latter exists, low doses should 
be instituted beginning at 0.5 to 1.0 grain (32 
to 64 mg) and increased by the same amount 
in increments at two-week intervals. This de- 
mands careful clinical judgment. 

Morphologic hypogonadism and nephroses 
should be ruled out before the drug is admin- 
istered. If hypopituitarism is present, the adre- 
nal deficiency must be corrected prior to 
starting the drug. 

Myxedematous patients are very sensitive to 
thyroid and dosage should be started at a very 
low level and increased gradually. 

Precaution. As with all thyroid preparations 
this drug will alter results of thyroid function 
tests. 

Adverse Reactions. Overdosage or too rapid 
increase in dosage may result in signs and 
symptoms of hyperthyroidism, such as men- 
strual irregularities, nervousness, cardiac ar- 
rhythmias, and angina pectoris. 

Dosage and Administration. Optimal dosage 
is usually determined by the patient's clinical 
response. Confirmatory tests include BMR, T 3 
,3I I resin sponge uptake, T 3 ' 31 l red cell up- 
take, Thyro Binding Index (TBI), and Achilles 
Tendon Reflex Test. Clinical experience has 
shown that a normal PBI (3.5-8 mcg/100 ml) 
will be obtained in patients made clinically 
euthyroid when the content of T 4 and T 3 is 
adequate. Dosage should be started in small 
amounts and increased gradually with incre- 
ments at intervals of one to two weeks. Usual 
maintenance dose is 0.5 to 3.0 grains (32 to 
190 mg) daily. 

Overdosage Symptoms. Headache, instability, 
nervousness, sweating, tachycardia, with un- 
usual bowel motility. Angina pectoris or con- 
gestive heart failure may be induced or 
aggravated. Shock may develop. Massive over- 
dosage may result in symptoms resembling 
thyroid storm. Chronic excessive dosage will 
produce the signs and symptoms of hyperthy- 
roidism. 

(Treatment: In shock, supportive measures 
should be utilized. Treatment of unrecognized 
adrenal insufficiency should be considered.) 
How Supplied. 'A grain; Vz grain; scored 1 
grain; V/z grain; scored 2 grain; 3 grain; and 
scored 5 grain tablets, in bottles of 100 and 
1000 . 

Full information available on request. 



WARNER/CHILCOTT 

Division, Warner-Lambert Company 
Morris Plains, New Jersey 07950 


PR-GP-31-B/ 


162 


Illinois Medical Journal 


President’s Page 



Federal PSRO 

vs 

Illinois Alternative 


We are faced with a dilemma. 

The decision of several component county medical societies and 
their affiliated foundations to pursue the federal PSRO initiative 
rather than the Illinois alternative has challenged the validity of 
the ISMS position on this critical issue. 

Because of these recent developments at the local level, I believe 
we must reassess the entire PSRO issue — including the ISMS position 
and its proposed alternative program. 

In an effort to resolve our dilemma, the Board of Trustees last 
month called for an objective evaluation of the situation through: 

• An opinion survey — conducted by an outside research firm — to 
determine physician attitudes on PSRO; 

• A special session of the House of Delegates in November to 
review the survey results and reassess its position on PSRO, and 

• An educational program which will outline the implications of 
PL92-603 and the options available to physicians. 

The educational program is extremely important since the schizo- 
phrenia displayed by Illinois medicine in dealing with PSRO partially 
can be attributed to an ignorance of the issues coupled with a mis- 
understanding of the law and the ISMS position. 

In order to achieve the unity necessary to cope with PSRO, I urge 
each of you to take advantage of this informational program . . . 
carefully weigh the alternatives . . . and make your feelings known 
to your delegates. 

The House of Delegates must have the benefit of the “grass roots” 
viewpoint to objectively evaluate its position. You have an oppor- 
tunity to make your views known on this critical issue. If you fail to 
seize it, charges that your state medical society refuses to consider 
your opinion are not valid. 

I urge you to participate in the decision making process, and to 
support the chosen course of action. 


f UL 


^!lllllllliilll!llllllllllil!!iilllllllllllllllllll!llllillllllll!llll!l||||||||!l||||||||||||||||||||||!l|||||||||||||||||l!H^ 


for September, 197-f 


169 




give pain killers?... prescribe freq 


give pain killers only? 

They relieve pain but may cause patient drug 
dependency and unnecessary sedation. 

prescribe frequent eating only? 

Frequent feeding helps buffer acid, but caloric, 
digestive, and social considerations make 
frequent eating both difficult and impractical. 

use antacids only? 

Antacids, like food, help neutralize 
or buffer stomach acidity. Their 
action is short, usually lasting 
only 1 to V/z hours (given four 
hours after a meal).* Some 
patients may require 
antacids every half hour. 



Indications: Pro-Banthine is effective as adjunctive therapy in the treat- 
ment of peptic ulcer. Dosage must be adjusted to the individual. 
Contraindications: Glaucoma, obstructive disease of the gastrointestinal 
tract, obstructive uropathy, intestinal atony, toxic megacolon, hiatal hernia 
associated with reflux esophagitis, or unstable cardiovascular adjustment 
in acute hemorrhage. 

Warnings: Patients with severe cardiac disease should be given this medi 
cation with caution. 

Fever and possibly heat stroke may occur due to anhidrosis. 

In theory a curare-like action may occur, with loss of voluntary muscle 


control. For such patients prompt and continuing artificial respiration 
should be applied until the drug effect has been exhausted. 

Diarrhea in an ileostomy patient may indicate obstruction, and this 
possibility should be considered before administering Pro-Banthlne. 
Precautions: Since varying degrees of urinary hesitancy may be evidenced 
by elderly males with prostatic hypertrophy, such patients should be 
advised to micturate at the time of taking the medication. 

Overdosage should be avoided in patients severely ill with ulcerative 
colitis. 

Adverse Reactions: Varying degrees of drying of salivary secretions may 


Abstracts of Board Actions 

August 3-4, 1974 Chicago 

These abstracts are published so that members of the Illinois State Medical Society may keep advised of the actions 
of the Board of Trustees. It covers only major actions and is not intended as a detailed report. Full minutes of the 
meetings are available upon any member’s request to the headquarters office of the ISMS. 

Membership Poll on PSRO 

The Board of Trustees authorized Decision Making Information, a Los Angeles 
opinion research firm, to conduct a study of physician attitudes on PSRO with 
the results to be presented at a special session of the House of Delegates in 
early November. 

The move was prompted by actions of several groups which have challenged-ap- 
parently with the support of county medical society leadership— the House of 
Delegates ' directive to refrain from involvement in the federal PSRO initiative. 

Beginning early next month. Decision Making Information will survey by mail a 
scientifically-selected sampling of ISMS members to determine what role, if 
any, ISMS should play in implementing PL 92-603. 

In response to a letter signed by the presidents of Chicago, Quad River and 
Northern Illinois Foundations for Medical Care, the Board indicated— unless 
otherwise directed by the House of Delegates this fall-it wills 

• Proceed with the development of IPSRO in accordance with House of Delegates 
directives. 

• Refrain from controversial activity in areas where local foundations have 
received or applied for federal PSRO planning grants except when called upon for 
assistance by local medical societies in those areas. 

• Reject involvement in the federal PSRO regulated program in accordance with 
the House of Delegates directives. 

In related action, the Illinois Foundation for Medical Care-at the request 
of local PSRO applicants-agreed to establish a unified data system suitable for 
use by local medical care foundations or reviewing units in the various type pro- 
grams now under consideration. 

Committee on National Health Insurance 

The Board directed the Governmental Affairs Council to set up a subcommittee 
to study national health insurance proposals and all major national health leg- 
islation. This committee is expected to utilize the expertise of those ISMS mem- 
bers serving on the AMA Speakers Bureau for National Health Insurance. 

Recommendations For AMA Appointments 

The following have been recommended for appointment to AMA councils and com- 
mittees : 

Drs. Alfred J. Faber, Glenview, Legislation ; Edward A. Piszczek, Chicago, En- 
vironmental, Occupational and Public Health; Jack Gibbs, Canton, Health Man- 
power; Kermit Mehlinger, Chicago, Alcoholism; Donald Stehr, Havana, Rural 
Health ; Robert T. Fox, Glenview, Scientific Assembly ; Robert C . Stepto, Chicago, 
Cancer; Julius Kowalski, Princeton, Exercise and Physical Fitness; Robert R. 
Hartman, Jacksonville, Maternal and Child Health; Bernard Cahill, Peoria, Med- 
ical Aspects of Sports ; Ralston Hannas, Evanston, Community Emergency Services ; 
Trudy F. Eisenman, Chicago, Cutaneous Health and Cosmetics; Fred Z. White, 
Chillicothe, Nursing; William M. Lees, Lincolnwood, Quackery; T. Vaithiana- 
than, Skokie, Transfusion and Transplantation, and Joseph O'Donnell, Glen 
Ellyn, Subcommittee on Health Care Financing. 

AMPAC Board Vacancy 

Willard C. Scrivner, M.D. , Belleville, has been nominated to replace Frank J. 
Jirka, Jr., M.D. , River Forest, on the AMPAC Board of Directors. The vacancy 
was created by Dr. Jirka' s recent election to the AMA Board of Trustees. 

(Continued on page 210) 


for September, 1974 


175 



DARVON 

COMPOUND-65 

65 mg. propoxyphene hydrochloride, 227 mg 
mg. phenacetin. and 32.4 mg caffeine 


100 mg. propoxyphene napsylate 
and 650 mg. acetaminophen 


176 


Illinois Medical Journal 




Personal History of Paget’s Disease 

Osteitis Deformans With Several Unusual 
Features and Their Control 


By Reuben Bard, M.D./Bay Harbor Island, Fla. 


As a physician I have been in the unique 
position of observing the development and course 
of Paget’s in myself over a period of 40 years. 
For the first 20 years it appeared progressively 
in many of my bones and the symptoms became 
severe and complicated. It reached the stage 
where I was almost always miserable and worked 
under duress. Then, in 1952, after much investi- 
gation a program of therapy was evolved giving 
me almost complete relief. Thus, for the past 20 
years I have been well enough and keen enough 
to again function as a busy physician. 

The first evidence of Paget’s was found in my 
pelvic bones, on X-rays in 1933, made in a 
check-up examination for a ureteral calculus. 
Later it was found in my skull, the bones of the 
shoulder and hip areas, and then in two lumbar 
vertebrae. 

My head has been growing larger and con- 
tinues to do so. The largest circumference is 26.5 
inches. Early X-rays showed osteoporosis cir- 
cumscripta, but this was less evident later. More 
pronounced since has been a growing number 
of irregular and circular areas of increased dens- 
ity affecting the outer table and diploe, and sub- 

REUBEN BARD, M.D., is a retired general practitioner. At the 
time of writing. Dr. Bard resided in Evanston. He is a graduate 
of the University of Illinois College of Medicine and was a 
member of the American Academy of Family Physicians. 


sequent thickening of the bones. By 1962 the 
X-rays showed the diploe to be three times the 
normal thickness. The sella turcica is large but 
not diseased. There is flattening of the base of 
the skull, and possible platybasia. Laminography 
of the skull, to check deafness in the right ear, 
disclosed increased density of the cochleae, with 
thickening of the bony walls, more pronounced 
on the right. 

The hard palate and superior maxilla protrude 
forward producing a prognathism that continues 
to increase even now. The upper teeth extend 
one-half inch beyond the lower teeth with a 
separation and palato-version of the ones in the 
left jaw. There is now an especially wide space 
between the first two upper incisors. 

X-rays in 1940 showed a marked kyphosis in 
the lumbar area, and Paget’s changes were found 
later in the second and third lumbar vertebrae. 
These are now dense, compressed and widened. 
There is a slow spreading of Paget’s in the 
humeri, the scapulae and the clavicles, and in 
the major bones of the pelvis. 

Also in 1940 X-rays showed groups of small 
calcifications outside the bones in both shoulders, 
one elbow and both hips. Such calcifications 
cleared and recurred repeatedly until 1952. 

I had symptoms typical for Paget’s such as 
backache and pains in the hips and down the 
legs. But my more distressing ones were atypical 


for September, 1974 


177 


and not described in the literature on the sub- 
ject. They include episodes of severe distress in 
the shoulders or the hips, similar to calcified 
bursitis or tendinitis. They usually followed such 
activities as golfing or bowling, and were some- 
times severe enough to confine me to bed. While 
headaches are usually ascribed to the skull in- 
volvement, I have noted that my headaches were 
due to another physiologic phenomenon. They 
were frequent and persistent, usually supraor- 
bital, but often involving the entire head. They 
appeared irregularly, unrelated to time, activity 
or emotional state, and were associated with 
progressively worsening mental dullness, declin- 
ing perception and impaired memory. I could 
not concentrate and my working efficiency de- 
teriorated appreciably. 

Between the years 1928 and 1952 I had many 
attacks of renal colic, followed by the pasage of 
small, rough, dark red stones less than 2 mm. in 
size. None was large enough for chemical analysis 
at that time. In 1952 probenecid (Benemid®) 
was prescribed for another reason, and there 
were no new calculi since. The exception was a 
fragmented calculus low in the left ureter re- 
moved by transvesical ureterotomy at the Mayo 
Clinic in March, 1954. The chemical analysis 
revealed calcium oxalate. 

Neuritis appeared in 1948 and continued to 
1952. It was associated with widely distributed 
areas of numbness, cold or warmth, and itching 
or pins and needles sensations. The latter were 
most distressing over the nose, ears and cheeks. 
There was burning of the tip of the tongue, my 
ears felt stuffed, and my throat had the sensation 
of a swollen uvula. I had a metallic taste. There 
were scattered subcutaneous fasciculations, and 
muscle cramps in the legs and feet. Later on the 
occurrence of sharp shooting pains through the 
perineum would make driving a car difficult. 

Pronounced visual difficulties also occurred. As 
I read, the words changed from clear to blurry 
and did not remain in focus. After a few minutes 
of reading the distress became too difficult to 
continue reading. Many ocular studies and cor- 
rections of refractive errors were only slightly 
helpful. The ophthalmologic findings were nar- 
rowing and tortuosity of the retinal arteries. A 
study in February, 1972, at the Bascom Palmer 
Eye Institute in Miami, Florida, did not reveal 
angioid streaks. 

Additional symptoms such as tinnitus and de- 
creased hearing in the right ear may be related 
to the Paget’s. My current cardiac problems are 
considered due to coronary heart disease, and 


despite a continuing high blood volume, the 
early signs of decompensation are not believed 
to result from a high output failure. Blood pres- 
sure has always been low, 120/64. Blood counts 
have always been within normal. 

When my bone pains were mild I got relief 
with such non-narcotic analgesies as aspirin or 
amidopyrine (Pyramidon®) and later when the 
joint pains were severe I got fair relief by in- 
jections of procaine into the painful areas. This 
was a procedure I used in the many cases of 
bursitis and subacromial tendinitis I saw fre- 
quently in the war years of 1941 to 1945. That 
was in the era as described by Jaffe 1 when “treat- 
ment was merely symptomatic and palliative” 
and even as recently as 1972, despite the possible 
breakthrough in therapy with the many new 
drugs under investigation, Ingelfinger 2 called 
Osteitis Deformans a “have not” disease that 
causes little stir. 

At one time my headaches were relieved with 
ergotrate and caffeine (Cafergot) but when as 
many as four tablets a day were only partially 
effective, I stopped using them as I feared pos- 
sible ergot effect on my arteries. At such times 
the temporal arteries were very distended and 
the pulsations were visible. 

Early in 1952 I made a concentrated investiga- 
tion to seek help and saw several medical au- 
thorities. The Director of the Oklahoma Medical 
Research Institute and Hospital in Oklahoma 
City advised me to use a moderate calcium in- 
take in my diet, Vitamin C one-half gram twice 
a day, and a high liquid intake. 

On October 15, 1952, I was admitted to the 
Max Pam Research Unit at Michael Reese Hos- 
pital, Chicago. It was determined that I had a 
high blood volume (See Table 1) . Blood volume 
determinations since then are included in Table 
1. The blood uric acid was found to be 8.0 nrg.% 
(See Table 2). My attending physician told me 
that “a uric acid of 8 meant hyperuricemia, and 
that meant gout.” 

A neurologic study 3 revealed “sensory dyses- 
thesias existing practically everywhere in the 
body, but chiefly over the trunk and the lower 
extremities.” Later when I was under care in the 
Mayo Clinic, Rochester, Minnesota, in March 
1954, a neurologic study showed no remnant of 
the dysesthesias. 

I was told that I had both Paget’s and gout. 
As the new uricosuric drug probenecid (Bene- 
mid®) was available. I was advised to use it, not 
only to treat the skeletal symptoms but also to 
see if it would relieve the headaches. 


178 


Illinois Medical Journal 


BLOOD 

VOLUME REPORTS 

10/17/52 

Total Blood Volume 

5960 

cc (N — 75 — 85/kg) 

Plasma Volume 

3800 

ce (N = 42 - 46/kg) 

Red Cell Mass 

2160 

CC 

ISOTOPE 1/2/64 

Total Blood Volume 

6200 


Blood Volume/kg 

86.1 


Red Cell Mass/kg 

34.4 

(N = 30 ± 5) 

Plasma Volume/kg 

51.7 

(Nrr 38 -48) 

ISOTOPE 6/23/69 

Whole Blood 

5600 

(N = 4900) 

Red Cell Volume 

2150 

(N= 2020) 

Plasma Volume 

3450 

(N = 2880) 

7/15/70 

Whole Blood 

6575 

(N = 4800) 

Red Cell Volume 

2520 

(N = 1920) 

Plasma Volume 

4059 

(N = 2820) 


Table 1 shows all available reports on blood 
volume studies. 


It must be noted that the coexistence of 
Paget’s and gout, while not common, has been 
reported at various times. 

Paget 4 in his hrst report on the disease re- 
corded three cases with gout. Talbot 5 in his book 
Gout lists the reports he found by several au- 
thors. Barry 6 in his book devoted only to Paget’s 
makes slight reference to its occurrence. 

My response to the probenecid was surprising 
and dramatic, even though my headaches were 
not relieved. In a short period all the neuritides 
cleared up and my eyes improved and then re- 
turned to normal. These improvements have con- 
tinued more than 20 years. I made a kind of con- 
trol test on myself in August, 1973. I withheld 
the medication and ate all foods, including liver. 
The serum uric acid preceding this test was 
4.8 mg.%. After this period of nontreatment it 
rose to 8.5 mg.%. I had to stop this experiment 
(Continued on page 184) 





TABLE 2 


Serum 






Alkaline 

Acid 

Uric 





Phosphorus 

Phosphotase 

Phosplio- 

Acid 



Date 

Calcium 

mg.% 

Bodansky 

tase 

mg.% 

Glucose 

Cholesterol 

3-4-40 

9.15 mg.% 

3.4 

9.48 




208 

3-23-51 



34.2 * 


5.0 

106 


2-23-52 

10-15-52 

11.0 mg.% 

3.5 

39.4 


8.0 

74 


7-13-53 

1 1 .0 mg. % 

4.0 

7.0 


3.6 



1-6-55 



11.3 





9-6-55 


6.1 

22.7 


4.8 


282 

9-22-58 

12.0 mg.% 


17.4 


6.6 


312 

10-30-59 

8.5 mg.% 


27.0 


4.4 


400 

9-12-60 

8.6 mg.% 

4.0 

49.0 


6.8 


376 

6-1-62 


2.6 

19.4 


4.0 


328 

6-22-63 


2.8 

16.2 


7.4 



12-6-63 

6.0 m.Eql. 

3.6 

32.4 


4.0 


336 

2-1-66 

5.2 m.Eql. 


51.6 


6.9 



3-2-67 



11.2 


5.8 


185 

5-6-68 

5.25 m.Eql. 


43.0 


6.6 

137 


2-12-69 



9.8 


6.0 

Glucose 

Tolerance 


5-20-69 

5.0 m.Eql. 

3.6 

37.5 

.75 


Normal 

319 



The following three are SMA-12: 




8-26-71 

9.9 mg.% 


Over 400 


5.7 



4-18-72 

10.1 mg.% 


Over 400 


5.7 



5-17-73 

9.3 mg.% 


Over 400 


4.8 



5-17-73 

8-31-73 



30.5 ** 


8.5 



* King-Armstrong * *Bodansky 

Note: Urea N (BU1\) 13 

on 2-12-69 





Table 2 shows a representative list of blood chemistry values. 


for September, 1971 


179 


The Bleeding Duodenal Ulcer 

By James R. Hines, M.D., and Larry Wilkholm, M.D./Chicago 


Approximately 10,000 Americans die yearly of 
peptic ulcer disease. Most of these deaths are due 
to hemorrhage and duodenal peptic ulcers ac- 
count for more than half of all bleeding from 
peptic ulcer diathesis. 

Upper gastrointestinal tract hemorrhage can 
be divided into massive or moderate bleeding. 
Massive bleeding is usually defined as bleeding 
that lowers the hemoglobin to eight grams or 
less, unstable vital signs after 1,500 cc. of whole 
blood, or signs of clinical shock. 1 - 2 Some authors 
have used the criterion of 2,000 cc. of blood 
transfusion, a blood pressure drop of 40 mm. hg. 
below the normal, or a loss of 30% of the blood 
volume in a three-day period. 3 * 5 Moderate hem- 
orrhage is one that requires less than three pints 
of blood and the patient lias no unstable vital 
signs. The latter usually has melena without 
hematemesis. 

Of all massive gastrointestinal tract bleeding 
only 15-25% is proven to be from a duodenal 
peptic ulcer. 6 However, when all massive upper 
gastrointestinal tract hemorrhages are studied, 
30% to 60% are shown to be from duodenal ul- 
cers. An average of several series reveals 45% to 
be proven duodenal ulcers; and another 20% of 
unknown site. 7-11 A large number of the pa- 
tients with hemorrhage from an unknown site 
may have bled from a duodenal ulcer. Municipal 
and veterans hospitals have a higher percentage 
that bleed from gastritis, multiple ulcerations, 
and esophageal varices. 8 - 12 

Immediate Management of 
Massive Hemorrhage 

The “four tube’’ system should be instituted 
at once. 13 The first tube is a large intrave- 
nous line inserted to draw blood for a blood 
count, to cross match for donor blood and to 

JAMES R. HINES, M.D., is Chairman, 
Department of Surgery, Welsey Pavilion 
Northwestern Memorial Hospital, Chi- 
cago and Professor of Surgery, North- 
western University Medical School. Dr. 
Hines, a general surgeon, has devel- 
oped the Hines pyloroplasty for peptic 
ulcer surgery. 

LARRY WIKHOLM, M.D., is an Instructor in Surgery at North- 
western University Medical School. 


start fluids. The second tube is a nasogastric 
tube to aspirate the stomach. This can be used 
for ice water lavage to help reduce bleeding, to 
observe for further bleeding, to measure the 
gastric acid, and to remove the gastric acids as 
a method of treatment. The fear that a nasogas- 
tric tube will re-start bleeding that has stopped 
is not justified. When the clinical signs and symp- 
toms point to bleeding esophageal varices, the 
Blakemore-Sengstacken tube can be substituted 
for the Levine tube. The third “tube” is an in- 
dwelling catheter in the urinary bladder in order 
to monitor urinary output. The fourth “tube” is 
a central venous line used to measure the central 
venous pressure and thus evaluate the balance 
between blood loss and replacement. These four 
procedures should be done in the emergency 
room as soon as the patient is examined. Whole 
blood should be replaced as it is lost. When the 
patient’s vital signs have stabilized, he can then 
be removed to an intensive care unit for con- 
tinuous monitoring. Patients should be taken 
directly to the operating room if one is unable to 
restore the vital signs in the emergency room. 

Diagnostic Methods in Massive Hemorrhage 

While some patients will have a proven his- 
tory of a specific disease (such as a duodenal 
peptic ulcer or esophageal varices) more than 
half are without a prior diagnosis. Examination 
of the contents of the nasogastric suction or of 
the vomitus is helpful. Large, soft dark clots may 
tend to make one think of bleeding varices. Cof- 
fee-ground material is more likely to be from a 
bleeding duodenal ulcer while a large amount of 
bright red blood coidd be from either a gastric 
or duodenal ulcer. A “vigorous” diagnostic ap- 
proach can help determine which cases will best 
respond to surgical management. 14 As soon as 
the patient’s vital signs are stabilized, a barium 
meal should be ordered. The stomach is aspi- 
rated and washed out just before the barium 
meal. Recent series have shown this examination 
to be 70% to 75% accurate. 7 - 8 * 13 Renewed inter- 
est in emergency esophagogastroscopy is due to 
improved techniques with non-rigid fiberoptic 
equipment. Reports now estimate 85% accuracy 
in diagnosis with the new instruments. The com- 



180 


Illinois Medical Journal 



bination of barium meal plus esophagogastros- 
copy has been estimated to be 95% accurate. 6 - 13 

Angiography has been useful in patients with 
obscure lesions 15 and in selected cases. 13 Blood 
loss must be in excess of 1 cc. min. for this test 
to be of value. 9 Liver function tests, especially 
the BSP, are helpful in cases of suspected liver 
damage with bleeding esophageal varices. 

We now employ both the emergency upper 
GI X-ray and emergency esophagogastroscopy in 
undiagnosed bleeding. Angiography has been 
used infrequently in massive bleeders but has 
been helpful in those patients that have had re- 
peated bleeding episodes. 

Non-Operative Management of 
Massive Bleeding 

Whole blood should be replaced as it is lost. 
The practice of allowing the patient to remain 
hypovolemic and hypotensive in order to en- 
hance clotting and to limit rebleeding is not 
justified. 16 Inadequate perfusion of the vital 
organs leads to strokes, myocardial infarction, 
pulmonary failure, renal tubular necrosis and 
hepatic failure, as well as to fatalities from ex- 
sanguination itself. A coagulation profile should 
be obtained and any deficiencies corrected. 

Ice water lavage of the stomach is helpful, 
especially in patients with gastritis or multiple 
bleeding sites, as vasoconstriction is induced by 
the iced water or saline. Local vasoconstrictors 
induced through the Levine tube have had little 
success. 

While most authors believe that continuous 
gastric aspiration is indicated in massive hemor- 
rhage, a few feel that instillation of antacids 
through the Levine tube is helpful. This has 
been used in patients that are considered unsuit- 
able candidates for any surgical procedure. An 
alternate method is to instill antacids for three 
hours and to aspirate the fourth hour. Anti- 
cholinergic drugs have been given by parenteral 
methods but their value is questionable. Seda- 
tives are helpful. 

Vasoconstrictors have been infused directly 
into the gastric arteries by arterial catheteriza- 
tion. 17 - 18 This is especially practical if the 
catheter is already in place for diagnostic angiog- 
raphy. Large doses of norepinephrine have been 
infused into these vessels without causing hyper- 
tension, as this drug has been found to be inac- 
tivated by one passage through the liver. 19 The 
vasoconstriction produced is probably temporary, 
which may account for the re-bleeding that has 
been reported. 20 

The mortality rate for “medical management” 


in massive bleeding from duodenal ulcers is un- 
known, as most of the medical failures are re- 
ferred for a surgical procedure. Retrospective 
studies indicate the mortality rate to be in the 
area of 15% to 25%. 5 Well controlled and statis- 
tically valid studies show that operative methods 
are better than non-operative in massive hemor- 
rhage, especially in selected cases. 21 - 22 

Management of Moderate Bleeding 

While these patients are henrodynamically 
stable, they must be carefully observed as sudden 
massive hemorrhage can occur at any time. Most 
of these patients are admitted with melena and 
often are without pain or hematemesis. In un- 
diagnosed cases a nasogastric tube is passed to 
determine if fresh blood is present and to test 
the acid levels. This tube will rarely reactivate 
bleeding if it is inserted carefully. The tube is 
removed if active bleeding has stopped and if 
the patient is not nauseated. 

Hourly feeding should be given, alternating 
milk and cream and other soft foods, with ant- 
acids. Anticholinergics are often given every 
four hours to diminish gastric secretion. How- 
ever, some authors feel that anticholinergics 
cause pylorospasm and the delayed emptying that 
results will adversely affect the treatment. Seda- 
tives are given as needed. 

The nature of the food ingested is probably 
less important than being sure that something 
is present to neutralize the digestive effect of the 
gastric and duodenal juices. 

In the absence of a Levine tube, a central 
venous line and a urinary catheter, it is impera- 
tive that vital signs be monitored hourly. During 
the first 48 hours hematocrit levels should be 
determined every eight hours. Serum gastrin lev- 
els by immunoassay have been used diagnostical- 
ly in some institutions and may be useful in 
predicting the type of treatment needed or as- 
sessing the effectiveness of a method of treatment. 

In all cases a barium meal should be ordered 
as soon as possible in order to establish the diag- 
nosis. Patients with known liver disease and 
esophageal varices may be bleeding from peptic 
ulcers rather than the varices. Esophagogastros- 
copy should be ordered when the barium meal 
is not diagnostic. A coagulation profile and liver 
function studies should be part of the routine 
management. A search must be made for drug 
sensitivities and the history of taking ulcerogenic 
drugs must be determined. Aspirin, butazolidin, 
tobacco, alcohol, coffee, steroids and other known 
gastric irritants should be eliminated. 


for September, 1974 


181 


Indications for Emergency Operation in 

Massive Bleeding from Duodenal 
Peptic Ulcers: 

1. Inability to maintain vital signs while re- 
placing blood. The rate of hemorrhage exceeds 
the rate of blood replacement. 2 

2. Continued bleeding after 48 hours of medi- 
cal management. 5 

3. Fifteen hundred cc. of blood replacement 
in any 24-hour period or one unit every eight 
hours. 2 ’ 7 

4. Recurrent hemorrhage after cessation of 
bleeding. The second hemorrhage is usually more 
severe than the first. 2 ’ 7 ’ 23 

5. Concommitant obstruction or perforation. 5 

6. Patients 50 years or older should he op- 
erated upon after three transfusions. Older pa- 
tients, especially if accompanied by a general 
medical disorder, are less able to compensate for 
the blood loss. 2 ’ 9 ’ 24-28 

Indications for Elective Surgical Procedures 
in Moderate Hemorrhages 

A moderate hemorrhage is defined as a bleed 
that requires less than three pints of blood to 
correct the vital signs, and at no time does the 
patient exhibit the signs or symptoms of shock. 
The indications for operation that we use are: 

1. Two moderate bleeds during any one 
hospitalization. 

2. Three moderate bleeds that require 
blood or plasma expanders. 

3. Two moderate bleeds in patients that are 
50 or older. 

4. Bleeding while on medical management. 

It is well established that if the bleeding can 

be stopped by medical management and the sur- 
gery performed electively, the patient will have 
a much greater chance for survival. 5 ’ 27 ’ 29 

Recently, we have tended to relax the indica- 
tions for operations in patients with moderate 
bleeding. With an operative procedure that has 
a low mortality and morbidity (vagotomy and 
wide pyloroplasty) we feel that better control of 
the nicer disease can be afforded by surgical 
rather than medical management. 30 

Mortality Rates in Operations for 
Bleeding Ulcers 

The mortality rate in emergency operations 
for massive bleeding from peptic ulcer disease is 
much higher than in elective operations. 13 ’ 29 ’ 31 
Mortality rates for emergency operations vary 
from 10% to 32% while the rate for non-emer- 


gency or early elective operations is 1% to 7%. 
An average of several series reveals 22% deaths 
in emergency operations and 3% deaths in elec- 
tive operations. The death rate is higher in older 
patients, those with concomitant serious illnesses, 
those that require multiple transfusions, and in 
re-bleeders. Death rates are higher in municipal 
hospitals than in private practice hospitals due 
to an older age group, late treatment, and more 
serious concomitant illnesses. 1-5,7,8,10, 13 , 24 - 29 , 31-35 

Selection of the Surgical Procedures in 
Massive Hemorrhage 

Almost all surgeons agree that vagotomy and 
oversewing of the bleeding point should be per- 
formed when operating for a bleeding duodenal 
ulcer. Controversy exists as to whether these pro- 
cedures should be accompanied by antrectomy or 
apyloroplasty. Recently Crook, et al, has averaged 
many series and has concluded that the mortality 
rate in vagotomy, ligation of the bleeder, and 
resection is about 20% while vagotomy, ligation 
of the bleeder, and pyloroplasty is about 
10%. 3 ’ 5 ’ 7 ’ 27 When multiple bleeding sites are 
present some surgeons believe a resection should 
be carried out 13 ’ 35 while other studies show that 
bleeding can be controlled by vagotomy and 
pyloroplasty. 36 Giant ulcers have a greater ten- 
dency to re-bleed and may need to be resected. 2 

The best operation for the massively bleeding 
duodenal ulcer is one that provides immediate 
control of the bleeding vessel and control of the 
ulcer diathesis with the lowest operative mor- 
tality rate. 2 Ligation of the bleeding vessels, 
pyloroplasty, and vagotomy achieves this re- 
sult. 4 ’ 10 ’ 12 ’ 23 ’ 26 - 28 ’ 34 ’ 37 

The Operative Procedure 

A midline incision is made from the xyphoid 
to the umbilicus. A truncal vagotomy is per- 
formed (unless severe uncontrollable hemor- 
rhage would dictate attacking the ulcer bleeding 
first) as a selective vagotomy is more time con- 
suming. We feel that performing the vagotomy 
first reduces contamination of the subphrenic 
space and reduces the handling of a newly su- 
tured gastroduodenotomy. 

A pre-pyloric gastrotomy is performed. This al- 
lows the operator to see if the bleeding is gastric 
or duodenal (if bleeding is active) as well as to 
palpate the intact pylorus for stenosis. The ex- 
amining finger can then palpate the antrum, 
pylorus and duodenum for ulcerations. The 
pyloric sphincter and duodenum are incised 
over the avascular anterior aspect making a 7 


182 


Illinois Medical Journal 


mm. gastroduodenotomy. A suction tip is used 
to clear the blood and carefully locate the bleed- 
ing site. The bleeding area is oversewn with two 

2.0 atraumatic non-absorbable sutures, one above 
and one below the vertical pancreaticoduodenal 
artery but not tied down. If the vessel is not 
bleeding it should be sponged to wipe away the 
clots until bleeding occurs. Thus, when the 
hemostatic sutures are tied down it can be de- 
termined that hemostasis is complete. A small 
suction tip again is used to keep the field clear 
of blood so that the bleeding vessel is carefully 
identified and sutured. When you find an in- 
durated ulcer base, use a small heavy curved 
needle as a thin needle may break. The stomach 
is then irrigated with sterile saline to see if a sec- 
ond bleeder is present. 27 If there is continued 
bleeding from the stomach, a separate, large gas- 
trotomy is made. A second bleeder is not uncom- 
mon and all the bleeding points should be 
localized and oversewn. A “blind” gastrectomy is 
to be avoided. 38 

If no additional bleeding point is found, 
mucosa over the back wall of the pylorus is 
opened, the pyloric muscle transected, and the 
mucosa and submucosa closed with interrupted 

3.0 non-absorable suture according to the Hines 
modification of the Heineke-Mikulicz pyloro- 
plasty. 39 The anterior wall is closed in a single 
layer according to the Weinberg modification of 
the Heineke-Mikulicz pyloroplasty. 27 The double 
transection of the pylorous destroys the sphincter 
action of this circular muscle and provides bet- 
ter gastric emptying. 39 

If the ulcer bleeding is attacked first the vago- 
tomy is performed after changing gowns, gloves 
and instruments. It must be pointed out that 
after ligating the bleeding point, you must con- 
tinue and do a drainage procedure and vago- 
tomy. Failure to complete all three procedures 
will result in a prohibitive recurrence rate. 2 ’ 27 
The vagotomy temporarily reduces the gastric 
blood flow as well as to control the ulcer dia- 
thesis. 40 - 41 

The post operative period requires careful 
monitoring to maintain blood and fluid balance 
and to be alert for continued or re-bleedine. We 

o 

use a nasogastric tube for the first 24-48 hours. 
Early removal of the nasogastric tube reduces 
pulmonary problems, makes for easier ambulation 
and lessens the fluid and electrolyte problems. 23 
The wide pyloroplasty lessens the possibility of 
post-operative gastric retention. We have recenlty 
performed vagotomy, double pyloroplasty and 
ligation of the bleeding point in 26 patients with 


bleeding duodenal ulcers. There has been no 
serious complication, no deaths, and no recur- 
rence of bleeding. 

A review of the literature reveals that there is 
a recurrence of bleeding in eight to 30% of pa- 
tients that have had surgical procedures for 
bleeding duodenal ulcers. 2 > 10 > 12 > 42 > 43 After sub- 
total gastrectomy, series vary from eight to 
33%. 32 > 43 > 44 Vagotomy and antrectomy have a 
recurrence of bleeding in six to 15% with a re- 
cently compiled series averaging 10%. 7 Vagotomy 
and pyloroplasty have recurrent bleeding in five 
to 26% of the cases, with the average recurrence 
at about 15%. 1 ’ 4 ’ 7 > 26 > 44 ’ 45 Of the recurrent bleed- 
ers, most are brought under control on med- 
ical management but about half of the mas- 
sive re-bleeders will need to have further 
surgery. 1 ’ 4 ’ 10 ’ 12 ’ 26 ’ 30 ’ 32 ’ 34 ’ 43 - 45 

It is apparent that the recurrence of bleeding 
is often related to inaccurate ligation of the 
bleeding vessel, incomplete vagotomy, and gas- 
tric stasis. With complete vagotomy, newer out- 
let procedures, and better vessel ligation all of 
these factors are greatly reduced. At this time 
we feel that the slightly higher recurrence rate 
following vagotomy and a drainage procedure 
(as compared to vagotomy and gastric resection) 
is justified by a much lower mortality and mor- 
bidity rate and is followed by less untoward post- 
operative sequelae. 1 ’ 2 ’ 46 ’ 47 

Recently, attention has been directed to reduc- 
ing recurrent bleeding by eliminating certain 
gastroduodenal irritants. Alcohol, tobacco, caf- 
feine, butazalidin, steroids, aspirin and other 
known ulcerogenic medications and drugs are 
eliminated. This should help reduce the recur- 
rences following any procedure. Long-term re- 
currence rates after prospective studies have 
tended to show an increased recurrence rate after 
vagotomy and drainage as compared to vagotomy 
and antrectomy. 46 - 48 These studies included all 
aspects of ulcer disease and would tend to show 
that under ideal conditions the mortality and 
morbidity rates are about the same in both pro- 
cedures and that the increased recurrence rates 
are related to a larger number of positive Hol- 
lander tests after vagotomy and pyloroplasty. 47 
In spite of these impressive studies most authors 
feel that in patients with bleeding duodenal ul- 
cers, vagotomy, ligation of the bleeding vessel, 
and pyloroplasty affords the best protection with 
the lowest mortality rate. 

Summary 

Bleeding from duodenal peptic ulcer disease 


for September, 1974 


183 


carries a formidable mortality rate. This mor- 
tality rate is higher in older patients, those who 
are admited late in their disease, those with 
serious concomitant medical illnesses, and those 
patients that have recurrent bleeding after cessa- 
tion on medical management. A large number of 
deaths are related to poor perfusion of the vital 
organs resulting in strokes, respiratory failure, 
myocardial infarction, and renal failure. Ade- 
quate perfusion must he maintained at all times, 
especially in patients with pre-existing diseases. 
A sound case can be made for early surgical in- 
tervention in massive bleeding from peptic ulcer 
disease, especially in patients over 50 years of 
age. Patients should have emergency operation 
to stop the bleeding if they have bled three pints 
in one day or seven pints in three days. 

Early elective operation after cessation of mas- 
sive bleeding appears to offer the best protection 
for the patient with bleeding duodenal ulcers. 

The authors feel that vagotomy, ligation of the 
bleeding point, and a widely patent pyloroplasty 
is the best treatment in both acute massive bleed- 
ing and as an elective operation for intermittant 
moderate bleeding. Patients with multiple bleed- 
ing points, giant ulcers, and those with extremely 
high acid levels are best treated by vagotomy, 
ligation of bleeding points and partial gas- 
trectomy. ◄ 

References 

A complete bibliography for “The Bleeding Duodenal 
Ulcer” may be obtained by writing to the Illinois Medical 
Journal, 360 N. Michigan Ave., Chicago 60601. 


Personal History of Paget’s 
Disease 

(Continued from page 179) 

after 8 days because I was having a recurrence of 
the old formications and my reading was again 
becoming distressful. 

My headaches, however, continued. In Novem- 
ber, 1952, after eating improper food I developed 
a severe gastroenteritis with pronounced dehy- 
dration. At this time I was struck by the absence 
of headache, and then reasoned that relief of 
headache resulted from the dehydration. I could 
then recall specific instances when headache oc- 
curred or was aggravated by high sodium intake. 
As I had read, many years before, that the blood 


volume in Paget’s of the skull might be in- 
creased, and knowing that this was shown recent- 
ly to be true in my case, I decided to test the 
effect of a minimal sodium intake. When I 
reached an intake of less than 500 mg. sodium 
a day, the response was very gratifying. Head- 
aches have been absent since. The dullness, poor 
comprehension and deficient memory all cleared 
up. I became more alert, was again able to study, 
and to take a deep interest in life and medicine 
which I have enjoyed the past 20 years. 

Conclusion 

Despite the occurrence of Paget’s in adults 
being reported up to 3%, only a small portion of 
these have extensive Paget’s with much disability. 
It is difficult to state in my case how much of my 
symptoms were due to Paget’s and how much to 
the related problems. While it is stated that the 
increased vascularity or possible neurologic con- 
ditions produce the headaches, I believe I have 
shown that my headaches are due to increases in 
the basic high blood volume, and that they are 
relieved or prevented by a diet with minimal 
sodium intake. 

Many of my skeletal distresses are evidently 
due to a concurrence of Paget’s, gout and pos- 
sibly degenerative osteoarthritis. 

Even though the generalized neuritides and 
the eye distresses are relieved by probenecid, I 
have been unable to find any mention or ex- 
planation for these phenomena. 

For many years I have had wide fluctuations 
in the alkaline phosphatase values, and I no- 
ticed the big increases coincided with periods of 
increased bone distresses. 

I am aware of all the recent work with new 
medications, but I was fortunate to solve my 
problems when there was nothing therapeutic 
known or investigated, 21 years ago. ■< 

References 

1. Jaffee, H. L.: Metabolic, Degenerative and Inflam- 
matory Diseases of Bone and Joints. Philadelphia, 
Lee and Febiger, p. 268. 

2. Ingelfinger, F. J.: Haves and Have Nots in the World 
of Disease. N. Engl. J. Med. 287:1198-1199, 1972 

3. Boshes. Louis: Personal communication, a copy of his 
report to Dr. R. Levine. 

4. Paget, J., on a Form of Chronic Inflammation of 
Bones— Osteitis Deformans. Trans. Med. Chir. Soc. 2nd 
series, 42:37-63, 1877. 

5. Talbot, John H.: Gout. New York, Grune and Strat- 
ton, p. 146, 1967. 

6. Barry, H. C.: Paget’s Disease of Bone. Baltimore, 
Williams and Wilkins, 1969. 


184 


Illmois Medical Journal 


Primary Ovarian Pregnancy 

By William Vulgaris, M.D. and Walter Reich, M.D. /Chicago 


Mercerus, in 1641, was the first to suggest the 
possibility of ovarian pregnancy, but the first 
case was reported by Saint Maurice de Perigod 
in France. The first accurate clinical and histo- 
logical study was made by Tussenbroek of Brus- 
sels in 1899. 

Ovarian pregnancies are classified as primary 
and secondary, with primary ovarian pregnancy 
being our subject in this paper. 

It has been stated repeatedly in almost every 
paper which deals with the present subject that 
primary ovarian pregnancy occurs once in every 
25,000 - 40,000 cases, and in 0.7% or 0.4% of 
ectopic pregnancies, although Tabor and Crossett 
go as high as 2.7%. Eckenson goes as low as 
0-29%. 

Titus claims that many “chocolate cysts” of 
the ovary were in reality ovarian pregnancies, 
but couldn’t be recognized because of early 
rupture of the sac, or because of degenerative 
changes occurring in pregnancy. 

In a review of the literature, we have collected 
21 1 reported authentic cases of primary ovarian 
pregnancy, including our own cases. 

Over a ten year period, in our hospital, out 
of a total of 13,320 deliveries, only one case 
of primary ovarian pregnancy has been observed, 
which we will discuss later in detail. 

WILLIAM VULGARIS, M.D., .s a sen- 
ior attending staff member at Grant 
Hospital, Chicago. Dr. Vulgaris previ- 
ously was an associate at Fantus Clinic, 
Cook County Hospital. He is a gradu- 
ate of National and Kapodistria Uni- 
versity, Athens, Greece. 


To classify a case of primary ovarian pregnancy 
as such, Spiegelberg in 1879 recorded his criteria 
for recognition of the abnormality: 

1. The tube on the affected side must be 
intact. 

2. The fetal sac must occupy the position 
of the ovary. 

3. The pregnancy must be connected to the 
uterus by the utero-ovarian ligament. 

4. There must be ovarian tissue in the sac 
wall. 

These rules are classic and have been unques- 
tionably accepted and followed. Williams adds 
to the above four rules that unquestionable 
ovarian tissue must be found at several places 
in the wall of the sac at some distance from 
each other. 

Miller, for the intrafollicular type of primary 
ovarian pregnancy, states that a section through 
the base of the ovum must reveal either a fresh 
corpus encircling the ovum, or it must disclose 
the ovum lying close to the corpus, which must 
show signs that the ovum has passed through it. 

Etiology of Primary Ovarian Pregnancy 

Mechanism of Ovarian Pregnancy 

Within recent years, Veit’s view has been ac- 
cepted that implantation is not necessarily within 
the follicle from rvhich the ovum was discharged. 
It is true that after its discharge the ovum may 
be fertilised and then take root in the follicle 
or corpus luteum (intrafollicular implantation), 
but these are soon penetrated by the trophoblast 
which pushes into deeper ovarium structure (jus- 
tafollicular implantation). However, the most 
common mechanism as Meyer asserts, in through 
cortical implantation of the egg. A logical ex- 
planation for this might be the great frequency 
with which endometrium is found in the ovary, 
and the probability, according to many, that this 
is due to the differentiating potency of the 
germinal epithelium. In many cases, however, 
there is much difficulty in establishing the meth- 




WALTER REICH, M.D., maintains a pri- 
vate practice in gynecology and is 
consultant at Cook County, Oak Forest 
and Grant Hospitals, Chicago. A grad- 
uate of the University of Illinois Col- 
lege of Medicine, he was a Professor 
of Gynecology at Cook County Grad- 
uate School of Medicine, 1934-1970. 
He Is the co-author of Practical Gyne- 
cology and Pitfalls in Gynecology Diagnosis and Surgery. 


for September, 1974 


185 


011 of implantation. 

Tubal pregnancy ruptures earlier than ovarian. 
Ovarian pregnancy terminates, usually, through 
early rupture, but may advance to full term, 
and the fetus succumb after a spurious labor, 
if operation is not carried out or it ends in 
lithopeilion formation. Approximately 75% are 
terminated in the hrst trimester; 12%% in sec- 
ond trimester; and 12%% in the third. 
Intrafollicular—Ovum implanted in the follicle. 

Leopold believes that the ovum which is 
impeded in its progress by a narrow tortuous 
channel, is held in its position while the sperm 
penetrates and fertilizes the ovum. Others be- 
lieve that the force of escaping intrafollicular 
fluid is not great enough to push the ovum out 
of the follicle covered by pathologic tunica al- 
buginae. Another explanation is that a small 
blood clot obstructs the ostium but this does 
not explain the sperm penetration. Still another 
explanation is that the ovum is discharged in 
the follicle and is not washed out by escaping 
fluid. 

Interstitial: 

The ovum is implanted in the interstitial 
tissue of the ovary. 

Peripheral: 

Superficial— e nidation occurs on the surface 
or just under it. The ovum burrows deeper or 
extends outward. This happens when the capsule 
is thickened due to old healed disease, ovarian 
endometriosis, peritoneal adhesion or cystic de- 
generation of the follicle before rupture. 

Suprafollicular— the ovum is an interstitial im- 
plantation, in which even if the ovum ruptures 
from the iollic it remains at the point of rupture. 

The most common types are the intrafollicular 
and the interstitial. Only 10% are extrafollicular. 
Some believe that the extrafollicular starts as 
intrafollicular. Barda reported a case which he 
believes was due to implantation in embryonic 
muellerian duct tissue. 

Shettles, in 1957, believed that primary ovarian 
pregnancy in the human is parthenogenetic in 
origin. This was investigated by David J. B. 
Ashley, by determining the sex of offspring of 

12 ovarian pregnancies. Several were found to 
have male nuclear sex and five were of female 
nuclear sex. So fertilisation precedes implanta- 
tion of the zygote. 

Secondary Ovarian Pregnancy: 

Secondary ovarian pregnancy is dislodged 
tubal pregnancy due to tubal obstruction from 
healed diseased tube, peritubal adhesions, and 
functional changes in the tunica albuginae. 


Novak claims that the ovum does not neces- 
sarily implant in the follicle from which it was 
discharged. F. M. Lyle and O. O. Christianson 
described a case of primary ovarian pregnancy 
1 1 years after vaginal hysterectomy, complicated 
postoperatively by fistula of the vaginal vault. 
Hydatiform mole and eclampsia have been re- 
ported accompanying primary ovarian pregnancy. 
Primary ovarian pregnancy implanted in endo- 
metrial cyst of the ovary was reported in two 
cases by Baten-Heinc and by B. Bercouici, et al. 
Repeat primary ovarian pregnancy was reported 
by John T. Pewters (1953) . Simultaneous intrau- 
terine pregnancy and primary ovarian pregnancy 
(Herman W. Rannels, 1953) also was reported. 

Symptomatology 

Age: The range was 18-41 years old. 

Race: There were 13 patients of the white race; 4 Negro, 

5 Chinese, 1 Indian, 1 Malay, 1 case of Spanish American 
descent and another 6 cases of unknown race, because 
the race was not recorded. 

Parity: Was from 0 to 12. 

Missed period: Missed period ranged from 1 - 44 weeks, 
with most of cases around: (a) the 8th week, and 
(b) the 4th week. 

Abdominal pain. Generalized abdominal pain was found in 
26 patients of which 1 patient complained also of pain 
in the rectum, nine of low abdominal pain and one of 
abdominal cramps. Three patients complained of LLQ 
quadrant localized pain and nine patients of pain in the 
Rt lower quadrant, 22 had generalized abdominal pain. 
One patient complained of periumbilical pain and one 
patient complained of generalized pain which spread 
to the lower back. There were three patients without 
abdominal pain. Ten patients complained of 
fainting, while vomitting and nausea was 
experienced by 26 patients. 

Morning sickness: one patient. 

Breast engorgement: five patients. 

Shoulder pain: twenty patients. 

Vaginal bleeding: was reported by thirty seven paients. 

The physical examination revealed: 

Abdominal tenderness at hypogastrium: 19 patients 
Generalized tenderness 26 patients 

Right lower quadrant: eight patients 
Left lower quadrant: two patients. 

Bib: seven patients. 

No abdominal tenderness: twenty patients. 

Rebound tenderness: twelve patients. 

Rigidity: Generalized: 1 1 cases 

Lower abdomen: 3 cases 
Distention: 3 cases 

Pelvic examination: Cervix was blue: 1 patient 
Cervix was soft: 10 patients 
Pain on cervical movement: 12 
Blood noticed from cervical canal: 1 1 cases 
Corpus: One case the corpus was 16 cent, above the 
symphysis. I'HT were present. This patient delivered 
normally an 8 lb. 2 oz. baby boy at term. At sterilization 
operation a week later a 7 cent, ovarian cyst was removed 
which proved to be an ovarian pregnancy. 

1 case had some enlargement of the uterus. 

Temperature: The highest temperature was 99.4° and the 


186 


Illinois Medical Journal 


lowest 96.4°: 

Blood pressure: 58/40, 90/40 - 144/65. 

Pulse: from 68 to 126 per minute. 

Shock: 10. 

Respirations: from 18 to 32 respirations p.m. 

Pregnancy test: Positive— 6 cases; Negative— 2 cases. 

Urine: Negative in 4 cases. 

Hemotocrit: 26% - 40.7% 

Hemoglobin: from 5.2 GM - 13.7 GM 
RBC’s from 2.040.000 - 4.570.000 
WBC’s from 5.300 - 27.500 
Differential: polys 52% - 92% 

Preoperative Diagnosis: 

1. Ovarian cyst (ruptured): 2 cases 

2. Corpus luteum: 1 case 

3. Threatened abortion: 2 cases 

4. Incomplete abortion: 1 case 

5. Intra-uterine pregnancy: 1 case 

6. Ectopic pregnancies: 31, of which 13 were 
diagnosed ruptured. 

7. Appendicitis perforated complicating 2nd month 
pregnancy: 1 case 

8. Acute appendicitis: 2 cases 

9. Impacted hemorrhagic cyst with intra-uterine 
pregnancy: 1 case 

10. Twisted ovarian cyst: 2 cases 

11. Endometrioma of ovary: 2 cases 

12. Hyclro-salpinx: 1 case 

13. Abdominal pregnancy 44 weeks (postmaturity): 

1 case and another case at 42 weeks. 

14. Metrorrhagia - endometriosis. 

Diagnostic procedures: Colpocentesis was performed on 
11 cases. Blood obtained in 10 of the cases. 

Dilatation and Curettage was performed only on 7 cases. 

1 case showed normal curettings. 

3 cases showed secretary endometrium. 

2 cases showed desidual reaction. 

1 case no curettings obtained. 

1 case showed physiologic hyperplasia of endometrium, 
proliferative phase. On opening the abdomen blood 
was found in 18 cases in the abdominal cavity, which 
averaged from 0 — 2000 cc. 

Operations: 

1. Salpingo-oophorectomy: 16 cases 

2. Salpingo-oophorectomy-appendectomy: 1 case 

3. Partial resection of ovary: left: 1 case, right: 4 cases 

4. Total abdominal hysterectomy and bil. 
salpingo-oophorectomy: 2 cases, solid mass extracted: 

1 case 

5. Excision of cyst of ovary: 9 cases 

6. Oophorectomy: 7 cases. 

7. Case of supervaginal hysterectomy with bil, 
salpingo-oophorectomy (Rt. ovarian pregnancy, 
endometriosis, fibromyomata). 

8. Case of vaginal delivery of full term infant. 

One week later in the process of sterilization operation 
a Rt ovarian cyst was found, which was resected 
and proved to be primary ovarian pregnancy. 

Postoperative Diagnosis: Pathology 

1 . Left ovarian pregnancy: 20, of which 2 contained 
embryo. Ruptured: 2 cases 

2. Right ovarian pregnancy: 37 of which contained 
embryo. Ruptured were 7 stated cases. 

3. One case contained embryo, but the side was not 
reported. 


Note: One case of the right ovarian pregnancy was associated 
with endometriosis and fibromyomata of the uterus. One Rt 
ovarian pregnancy was twin. 

4. One right ovarian pregnancy was associated with 
intra-uterine pregnancy, which was complicated by 
toxemia of pregnancy and intra-uterine pregnancy, 
went to term and delivered an 8 lb. 2 oz. baby boy. 

The ovarian pregnancy was found one week later, 
when sterilization was performed. 

5. There is one case of right ovarian pregnancy which 
was operated and a right salpingo-oophorectomy 
was done. Twenty-six months later, the patient 
developed a left ovarian pregnancy. 

There were four D and C’s stated, of which two 

showed secretory cells and another two decidual. 
Mortality: All cases of the present series survived the operation. 

Case History 

A 24-year-olcl white married woman was ad- 
mitted to the hospital on 1/22/61, complaining 
chiefly of some vaginal bleeding, and slight 
tenderness at LLQ and lower back. She was 
nauseated and had engorged breasts. 

Past History: Tonsillectomy in childhood and 
infectious mononucleosis. 

Family History: An older sister was operated 
by the author for left tubal pregnancy in 1953. 

Menstrual History: Menarche was at the age 
of 11, with subsequent menstruation at intervals 
of 28 days, and duration of flow of four days. 

She was Para II (two full term pregnancies) and 
one miscarriage at the 3rd month in 1959. 

Present Illness: The last menstrual period 
was on Nov. 18, 1960. In December she missed 
her monthly period. January 3, 1961, she started 
a menstrual period which continued until Jan- 
uary 10, 1961. Next day the patient had minimal 
amount of vaginal spottings. Pain in LLQ 
became stronger. During this period she passed 
many clots and had cramps the first two days. 

This bleeding recurred on January 13, 1961, 
with smaller clots. It lasted until January 19, 

1961. At this time bleeding stopped completely. 

Physical Examination: The patient was in no 
acute distress, comfortable and had a pulse of 
80 per minute, blood pressure 130/80 and 
respiration 20 per minute. The breasts were 
engorged. The heart was normal in size and 
no murmurs were present. The abdomen was 
soft, tender at LLQ. The liver was normal on 
palpation. The spleen was not palpable. No 
abdominal rigidity or rebound tenderness was 
present. On pelvic examination, the external 
genitalia appeared normal. The cervix felt hard 
and was in the middle line. The external os was 
that of a multiparous female with no blood pre- 
sent. There was a tender mass at left adnexa. 


for September, 1974 


187 


The right adnexa was normal on palpation. The 
corpus was of normal size. There were no masses 
in the cul-de-sac. 

Laboratory Findings: Hematocrit was 41% WBC 
15,800. The differential was polymorphonuclear 
cells 52%, lymphocytes 43%, monocytes 1%, 
eosinophiles 4%, blood glucose 71 mg. Urea 
nitrogen 8, Kahn was negative. 

Urine: Ph 6.0, glucose zero, protein zero. 
Ketone bodies were negative. Leukocytes 1-4, 
erythrocytes zero. A few bacteria were visible 
(voided) . Pregnancy test was positive. Diagnosis 
was that of left ectropic pregnancy. 

“Dilatation and curettage” was performed and 
a moderate amount of material was obtained. 
Colpocentesis was clone and there was old blood 
in the peritoneal cavity. An abdominal incision 
was made. A mass on the left side was found, 
which was old blood clot about the size of an 
English walnut, plus the ovary and the tube. 
These three structures were adherent to the 
sigmoid. The operative procedure was a separa- 
tion of adhesions, a left salpingo-oophorectomy 
was performed. 

Pathology Report: “Specimen of left tube and 
ovary.” Gross Diagnosis: Recent hemorrhage of 
ovary. The fresh specimen consisted of a uterine 
tube and attached its corresponding ovary. The 
specimen had been previously opened and some 
blood clots were seen closely attached. 

The uterine tube measured 5 cm., it had a 
bright red exterior with a tortuous appearance. 
On section, the cut surface was not remarkable. 
The fimbria was present and between it and 
the ovary was a blood clot. The ovary presented 
an oval shape with a tannish-gray exterior. On 
section, the cut surface of the ovary was shiny, 
bright red in color and presents the end of a 
small blood clot attached. Representative sec- 
tions were imbedded. 

Specimen of I-Endometrial scrapings 11-Cer- 
vical polyp: Gross-II— The specimen in formalin 
consisted of several small soft fragments of red- 
dish-tan tissue occupying a volume of about 2 
ml. imbedded in toto. Ill — The specimen in 
formalin consisted of a few short irregular frag- 
ments of grayish-tan tissue occupying a volume 
of about 0.6 ml. No definite polyp could be 
identified. Imbedded in toto. 

Microscopic /—Sections of the entire specimen 
showed fragments of endometrium containing 
moderate number of glands. The glands were 
lined by tall columnar epithelium with slight 
tendency to stratify with empty small lumina. 
No subnuciear vacules were seen and the sur- 


rounding stroma reveal beginning edema and 
congestion. //—Sections of the entire specimen 
revealed similar tissue as seen above. Nowhere 
in the entire sections was a polyp seen. 

Diagnosis /- and //—Physiological hyperplasia 
of endometrium, proliferative phase. 

Note: The hyperplasia seen in I and II was 
like that seen on the 14th day of a 28 day 
menstrual cycle. (See Figures) 



Microscopic sections showed ovary, somewhat 
fibrotic and containing numerous corpus albi- 
cans and mature follicles mingled with some 
(Continued on page 226) 


188 


Illinois Medical Journal 


Rehabilitation of the Patient 
With Chronic Low Back Pain 


By Aaron M. Rosenthal, M.D. /Chicago 


P atients with chronic pain in the low back 
commonly are seen by most physicians . 1 
Although the cause lor the pain may not be 
readily apparent, it is essential that a detailed 
diagnostic work-up be performed. In many in- 
stances this will illuminate the cause and make 
it possible to institute a course of treatment 
which is curative. 

However, there are some instances in which 
the cause remains obscure despite a complete 
diagnostic survey. In these cases, symptomatic 
therapy may not be very successful. Indeed, some 
patients continue to complain of low back pain 
despite the institution of all sorts of treatment, 
including the use of analgesics, local heat, local 
cold, corticosteroid therapy, pelvic traction, 
laminectomy and even spinal fusion. 

How then should these hard core cases be 
treated in order to relieve their backache? It is 
my opinion that we need to treat the patient’s 
psychological, social and vocational problems as 
well as his physical pain if we are to achieve a 
degree of success. Directing our therapy exclu- 
sively to the back will not help many of these 
hard core cases. 

A patient who has been hampered by chronic 
low back disability is often unable to work to 
support himself and his family. This creates a 
financial problem which may require the pa- 
tient to seek help from public welfare or from 
workman’s compensation. In some circumstances, 
the patient’s spouse may be forced to seek em- 
ployment and this may require a reversal of 
roles in the family. The male patient may be 
obliged to become the homemaker and this 
sometimes produces psychological effects. 

It is evident, therefore, that many patients 
with low back pain also suffer from psychological, 

AARON M. ROSENTHAL, M.D., is Di- 
recfor, Physical Medicine and Rehabili- 
tation at London Memorial (formerly 
Fox River) and Weiss Memorial Hospi- 
tals, Chicago. A graduate of Jefferson 
Medical College, Philadelphia, Dr. 
Rosenthal is active on the ISMS Coun- 
cil on Social and Medical Services. 


social and vocational consequences. A success- 
ful outcome may require probing in these areas 
and may require skillful counseling. The con- 
cerned physician must understand his patient’s 
life style and deal with it to reach successful 
resolution of the backache. 

In some instances it may be best for the 
patient to be hospitalized to enable the physician 
to perform a careful, complete diagnostic evalua- 
tion. It should be emphasized that history taking 
should be sufficiently detailed to determine 
whether there are psychological elements which 
have contributed to the persistence of back pain. 
In addition, the possibility of secondary economic 
gain should be explored. In certain instances 
a man with chronic disabling low back pain can 
receive disability benefits which provide him with 
more tax free dollars than lie could earn as a 
productive worker. 

A careful physical examination should follow 
the history taking in order to determine whether 
there is objective evidence of local musculo- 
skeletal pathology. The absence of such evidence 
may suggest the importance of psychological 
factors in the production of back symptoms . 2 

Laboratory confirmation logically follows. 
X-ray of the lumbosacral spine and electromyog- 
raphy should be performed routinely to deter- 
mine if there is bone, joint disease, nerve root 
compression or intrinsic myopathy. Additional 
studies such as pantopaque myelography should 
be performed if one suspects intervertebral disc 
protrusion or spinal cord tumor. 

It must be emphasized that if the results of 
these studies are negative, the physician should 
continue his scrupulous survey . 3 Additional in- 
formation can be obtained from psychological 
testing, psychiatric consultation or from social 
service evaluation. This is particularly true for 
those patients in whom psychological factors 
are suspected to be important in the persistence 
of the backache. 

When all of this information has been ac- 
cumulated, the physician should review and 
evaluate it in order to institute a reasonable 
course of management. The treatment plan 



for September, 1974 


189 



should work if it takes into account all of the 
factors which produced the symptoms. The 
thrust of the program is multifaceted in order 
to meet the patient’s needs. The basic program 
should include back exercise, extrinsic back 
support, psychological counseling and vocational 
evaluation. 

The simplest, most effective method for exercis- 
ing the back is by means of the Williams 
exercise routine (see figures) . The exercise be- 
gins with the patient lying Hat in the supine 
position. He keeps his pelvis flat against the 
table surface and then raises his head, neck and 
trunk to a sitting position without the help 
of his hands. This maneuver is performed ten 
times at one session. The patient repeats these 
ten repetitions two or three times per day. 
As a result, he will strengthen his abdominal 
muscles and will stretch his erector spinae 
muscles. 

In addition, the patient is taught to bend 
to pick up objects by maintaining a straight 
spine and by flexing at the knees and hips. 


This puts the stress on the bony components 
which can withstand them rather than on the 
soft tissues which cannot. The normal spine 
can withstand a great deal of compressive force 
without injury whereas shear force stresses are 
poorly tolerated. 

In addition to the exercise routine, a back 
brace or corset should be worn when not exercis- 
ing to give the patient extrinsic support. This 
support is indicated especially for those patients 
with recurrent, disabling back pain. A variety 
of corsets and braces are available but we prefer 
to prescribe a Hoke corset or a Knight Spinal 
back brace. Both of these give high back support 
by means of paravertebral stays. It must be men- 
tioned that women accept corseting more readily 
than men. Patients with severe back disability 
do better with a Knight brace than with a corset. 

For about three months the back support 
should be worn at all times except during exer- 
cise, bathing and sleep. If the patient does well, 
then he should be weaned from the device grad- 
ually. However, it is important to note that 
whenever the patient anticipates that he will 
engage in a stressfnl activity he should wear the 
support. 

Concurrently with the prescription of exercise 
and back support, there should also be psycho 
logical counseling. Opportunities should be made 
available for patients to discuss their problems, 
which may be producing the back pain, to de- 
velop insight about this. As a consequence, the 
back pain may disappear. Such a happy outcome, 
of course, may take some time but this does 
happen as a result of psychotherapy. Sometimes 
group therapy may be beneficial, particularly 
if the group is composed of patients with similar 
symptoms. 

For rehabilitation to become complete and 
to remain effective, the patient should be able 
to return to productive work. Vocational evalua- 
tion and vocational counseling may be useful 
in order to achieve this goal. Most people who 
need to earn a living can perform some occupa- 
tional lask even with chronic low back pain. The 
trick is to match skills, interest and patient per- 
formance with the local labor market. 

Sometimes, a graduated program can be started 
in which the patient begins in a sheltered set- 
ting, moves on to part-time employment and 
may even be able to reach full-time work in due 
time. In order to work, patients need to feel 
comfortable. They need to find out that care- 
fully selected work will not aggravate their 
backache. Employers and workmen’s compensa- 
(Continued on page 223) 


190 


Illinois Medical Journal 


a^ekg of tfie i noiit l i 


John R. Tobin, M.D., M.S., Rimgaudas, Nemickas, M.D., 
Patrick J. Scanlon, M.D., John F. Moran, M.S., M.D., 
James V. Talano, M.D., Sarah Johnson, M.D. and 
Rolf M. Gunnar, M.D., M.S. /Section of Cardiology, 
Loyola University Stritch School of Medicine 



A 63-year-old man presents to the office for evaluation of recurrent nagging 
epigastric distress. It awakens him from sleep in the early morning hours. It seems 
to be relieved by milk, food, or antacid therapy. He is afraid he has developed an 
ulcer. Fourteen months earlier he sustained a myocardial infarction elsewhere for 
which he was in the hospital for six weeks. An upper G.I. series shows an ulcer 
crater in the duodenum. The ECG is presented. 


Questions: 

1. The 12 lead ECG shows: 

A. An anterospetal myocardial infarction. 

B. Complete right bundle branch block. 

C. Left axis deviation or left anterior hemi- 
block. 

D. Complete left bundle branch block. 

E. First degree AV block. 

2. The following statements are true : 

A. This patient has severe coronary artery 
disease. 


B. This patient might be in danger of com- 
plete heart block. 

C. A pacemaker should be implanted. 

D. A recording of the patient’s bundle elec- 
trogram could be helpful from a prog- 
nostic viewpoint. 

E. A careful review of the records of the hos- 
pitalization for myocardial infarction 
should be done. 

(Answers on page 222) 


for September, 1974 


191 



One Response on Chiropractic Treatment 

Ed. note.: Recently the IMJ carried an article on chiropractic (April, 1974, Vol. 145, No. 4, pages 326-332) and 
asked for comment from the membership. Several items have been submitted. One of the most illustrative is that 
of a child being treated for epilepsy. The workup is published here so the membership might be alerted to the 
methodology being followed by chiropractic. Confidentiality of all parties, of course, is protected and thus no 
physical data or other identification is included. Fortunately the child was sent to one of the members before the 
"work” was started or the "savings” realized. The patient is now seizure-free. But “ practitioner ” in this case is 
the only “doctor” in the small town. 


Dr.___ 

Chiropractor 
— ■■■ — Illinois 

CHIROPRACTIC EXAMINATION AND RECOMMENDATIONS 


Confidential Report 


Date 

In c t to make the facts of this report quite clear, a short explanation of the basic principle of the chiropractic 
approa to better health is first necessary. 

The c.octor of chiropractic works directly and indirectly with both the spinal column and nervous system. As every 
function in your body is under the influence of the nervous system, disturbances in spinal balance and nervous 
equilibrium will have important effects. 

Chiropractic has special methods for finding and correcting these disturbances that can effect nerve function in many 
parts of the body. 

As a result of our examination and correlation of findings, it is considered that your case be treated with chiro- 
practic methods. It is recommended that you give this report careful study and consideration. 


Yours sincerely, 


•> 


D.C. 


192 


Illinois Medical Journal 




Chief Complaint: Epilepsy 

Secondary Complaints: Nervousness, convulsions, poor 
appetite, colds, nasal obstruction, allergy, chills, headaches, 
itching. 

Examinations Made: Personal consultation and inter- 
view, Preliminary spinal palpation and exam.. General 
physical exam.. Neurological exam.. Orthopedic exam., 
Neurocalometer exam., Chirometer exam., Neurolograph 
exam., and x-ray studies which included the lateral 
cervical spine, anterior cervical spine, and dorsal spine. 
Questionnaire Findings: Show a number of general 
symptons. The muscle and joint structure show a weak- 
ness of the cervical area of the spine. The gastro-intestinal 
tract gives evidence of a digestive problem which is 
responsible for the poor appetite. The Cardio-vascular 
system gives no evidence of malfunction. The nasal ob- 
struction is related to a sinus condition. 

X-ray Studies and Spinal Analysis: The spinal examina- 
tion showed areas of nerve pressure. A major pressure 
area is located at the atlas-axes area where the nerve 
carrying the life force to the body passes between the 
vertebrae. Minor pressure areas are located at the first 
and second dorsal vertebrae where the nerves to the 
spine pass between the vertebrae. The spinal X-rays show 
a definite spinal curvature which is of long standing. 
The dorsal view shows that the curvature has been 
developing over a long period of time. The lateral view 
shows a lordosis condition which is developing rapidly. 
The AP view shows a definite side slip of the atlas 
vertebrae. Also the axis and atlas vertebrae are rotated 
severely. It is my opinion that the atlas vertebrae is 
subluxated and causing a nerve interference in this area 
of the spine. With a nerve block of this type you can 
expect to be under chiropractic care for a definite period 
of time. A complete correction of the spinal nerve block 
is the answer to the health problem. With a complete 
correction a return to better health will follow. 

Chiropractic Physical Examination Findings: 

Age: Weight: blood pressure: 

Pulse: Other findings essentially normal 

except the above secondary complaints. 

Impressor: There appears to be a definite relationship 
between your chief complaint and the findings of the 
comprehensive examination. The misalignments found in 
the area of major nerve interference correspond to the 
other vertebral misalignments. The human spine can 
accept only so much correction at any one time. Treat- 
ment must be directed toward correcting the vertebral 
misalignments associated with the nerve interference at 
the area of involvement. It is very possible that com- 
pensatory changes resulting from this primary correction 
of the area of major nerve interference will alter the 
spinal structure in such a way as to reduce the nerve 
interference that is causing some of the secondary prob- 
lems. It should be clearly understood that this case is 
being accepted on the basis of treatment of the chief 
complaint only, even though improvement is anticipated 
in secondary problems. 

Recommendations: As we wish the very best of health 
for each patient accepted, we recommend a program 


that will provide a solid foundation for the future. The 
ideal situation is not only to arrest the present develop- 
ment and deterioration of your condition, but further to 
provide a progressive improvement as the forces of na- 
ture in your body become increasingly effective. 

In your particular situation, the facts of the examina- 
tion and our experience with similar cases, suggest that 
you follow a course of initial correction for a period 
of approximately 8 weeks. During this time you will 
need to come to this office for 20 visits. This program 
will start with: 

4 weeks, three visits per week 
4 weeks, two visits per week 

Chiropractic adjustments will be given to reduce the 
vertebral misalignments and nerve interference. Spinal 
exercises will be given to strengthen spinal muscles and 
give added holding support to the vertebral column. 

At the end of this recommended course of initial cor- 
rection, we will determine the progress you have made 
by making a detailed comparative chiropractic physical 
examination (including X-ray studies.) As you follow the 
principles decided for you, and spend the time neces- 
sary, the forces of nature in your body with the help 
of the nervous system will then produce maximum 
correction. 

Fee schedule: The following fee schedule does not in- 
clude the cost of the original examination and x-ray 
studies. 

For the recommendation initial correction care you may 
choose any of the following plans. 

Plan 1: If we must bill you or your insurance company. 
$6.00 per call. 20 adjustments @$6.00=$120.00 
Re-exam, and x-rays at the end of 8 weeks $25.50 
Total: $145.50 

Plan 2: If paid as received, $5.00 per call. 

20 adjustments @$5.00— $100.00 
Re-exam, and x-rays at the end of 8 weeks $25.50 
Total: $125.50. SAVINGS: $20.00 
Plan 3: If you prefer you can prepay the beginning of 
each 10 calls and receive a bookkeeping savings 
of 10%, plus a savings of (\/ 2 price) on Re-exam, 
and x-rays. 

No. 1 payment: 10 calls $45.00 

No. 2 payment: 10 calls $45.00 

Re-exam, and x-rays at the end of 8 weeks (i/ 2 

price) $12.75 

Total: $102.75. SAVINGS: $42.75. 

Plan 4: If you prefer you may prepay the total amount 
in the beginning and you will receive a book- 
keeping savings of 10% plus no charge for re- 
exam. and comparative x-rays. 

20 adjustments @$5.00 - less 10% discount 
Re-exam, and X-rays at the end of 8 weeks— 
no charge. 

Total: $90.00. SAVINGS $55.50. 

The Chiropractic Assistant at the front desk will answer 
any questions you might have these payment plans. 
Please speak with her today about which plan will be 
the most convenient for you. 


for September, 1974 


193 


The Role 
of the 

Detail Man 


Dr. Willard Gobbell 
Family Physician 
Encino, California 



“I may be prejudiced, but I am 
very much in favor of the detail men 
I meet. Most of them are knowledge- 
able about the drugs they promote 
and cab be a great help in acquaint- 
ing me with new medication.” 

Family Physician’s Perception 

I think that most general 
practitioners in this area feel as I 
doaboutthe detail man. Overthe 
years I have gotten to know most of 
the men who visit me regularly and 
they in turn have become aware of 
my particular interests and the na- 
ture of my practice. They, there- 
fore, limit their discussion as much 
as possible to the areas of interest 
to me. Since I usually see the same 
representative again in future 
visits, it is in his best interest to 
supply me with the most honest, 
factual, as well as up-to-date 
information about his products. 



Dr. Jeremiah Stamler 
Chairman 
Department of Community 
Health and Preventive 
Medicine, and Dingman 
Professor of Cardiology 
Northwestern University 
Medical School 




“In the total picture of dealing 
with health problems in this country, 
there is a potential for detail men 
to play a meaningful role.” 

The Positive Influence 

My contact with representa- 
tives and salesmen of the pharma- 
ceutical industry is the type of con- 
tact that people in a medical center, 
research people, and academic 
people have and that’s in all likelihood 
on a somewhat different level from 
that of the practicing physician. 

Let me touch on how I person- 
ally perceive the role of the sales 
representative. These men reach 
large numbers of health profes- 
sionals. Thus they could be — and 
at times actually are — dissemina- 
tors of useful information. They 
could consistently serve a real edu- 
cational function in their ability to 
discuss their products. 

At present they do distribute 
printed material, brochures and 
pamphlets — some of it scientific- 
ally sound and therefore truly use- 
ful— as well as some excellent films 
produced by the pharmaceutical 
industry. When they function in this 


194 


Illinois Medical Journal 



Is He a Source of Information? 

Yes, with certain reservations. 
The average sales representative 
has a great fund of information 
about the drug products he is re- 
sponsible for. He is usually able to 
answer most questions fully and 
intelligently. He can also supply 
reprints of articles that contain a 
great deal of information. Here, 
too, I exercise some caution. I usu- 
ally accept most of the statements 
and opinions that I find in the 
papers and studies which come 
from the larger teachingfacilities. 

It goes without saying that a physi- 
cian should also rely on other 
sources for his information on 
pharmacology. 

Training of Sales Representatives 

Ideally, a candidate for the 
position as a sales representative 
of a pharmaceutical company 
should be a graduate pharmacist 
who has a questioning mind. I don’t 
i think this is possible in every case, 
and so it becomes the responsibility 


capacity they are indeed useful; 
particularly in the fact that they 
disseminate broadly based educa- 
tional material and serve not just 
as “pushers" of theirdrugs. 

The Other Side of the Coin 

Obviously, the pharmaceuti- 
cal companies are not producing all 
this material as a labor of love — 
they are in the business of selling 
products for profit. In this regard 
the ambitious and improperly moti- 
vated sales representative can 
exert a negative influence on the 
practicing physician, both by pre- 
senting a one-sided picture of his 
product, and by encouraging the 
practitioner to depend too heavily 
on drugs for his total therapy. In 
these ways, the salesman has often 
distorted objective reality and 
undermined his potential role as an 
educator. 

The Industry Responsibility 

Since the detail man must be 
an information resource as well as 
a representative of his particular 
pharmaceutical company, he 
should be carefully selected and 


of the pharmaceutical company to 
train these individuals comprehen- 
sively. It is of very great importance 
that the detail man’s knowledge of 
the product he represents be con- 
stantly reviewed as well as up- 
dated. This phase of the sales rep- 
resentative’s education should be a 
major responsibility of the medical 
department of the pharmaceutical 
company. 

I am certain that most of these 
companies take special care to give 
their detail men a great deal of in- 
formation about the products they 
produce — information about indi- 
cations, contraindications, side 
effects and precautions. Yet, al- 
though most of the detail men are 
well informed, some, unfortunately, 
are not. It might be helpful if sales 
representatives were reassessed 
every few years to determine 
whether or not they are able to ful- 
fill their important function. Inci- 
dentally, I feel the same way about 
periodic assessments of everyone 


in the health care field, whether 
they be general practitioners, sur- 
geons or salesmen. 

Value of Sampling 

I personally am in favor of 
limited sampling. I do not use 
sampling in order to perform clini- 
cal testing of a drug. I feel that drug 
testing should rightly be left to the 
pharmacology researcher and to 
the large teaching institutions 
where such testing can be done in 
a controlled environment. 

I do not use samples as a 
“starter dose” for my patients. I do, 
however, find samples of drugs to 
be of value in that they permit me to 
see what the particular medication 
looks like. I get to see the various 
forms of the particular medication 
atfirst hand, and if it is in a liquid 
form I take the time to taste it. In 
that way I am able to give my pa- 
tients more complete information 
about the particular medications 
that I prescribe for them. 


thoroughly trained. That training, 
perforce, must be an ongoing one. 
There must be a continuing battle 
within and with the pharmaceutical 
industry for high quality not only in 
the selection and training of its 
sales representatives, but also in 
the development of all of its promo- 
tional and educational material. 

The industry must be ready to 
accept constructive as well as cor- 
rective criticism from experts in 
the field and consumer spokesmen, 
and be willing to accept independ- 
ent peer review. The better edu- 
cated and prepared the salesman 
is, the more medically accurate his 
materials, the better off the phar- 
maceutical industry, health pro- 
fessionals and the public— i.e., the 
patients — will be. 

Physician Responsibility 

The practicing physician is in 
constant need of up-dated informa- 
tion on therapeutics, including 
drugs. He should and does make 
use of drug information and an- 
swers to specific questions sup- 
plied by the pharmaceutical repre T 
sentative. However, that informa- 


tion must not be his main source of 
continuing education. The practi- 
tioner must keep up with what is 
current by making use of scientific 
journals, refresher courses, and 
informatiori received at scientific 
meetings. 

The practicing physician not 
only has the right, but has the re- 
sponsibility to demand that the 
pharmaceutical company and its 
representatives supply a high level 
of valid and useful information. I 
feel certain that if such a high level 
is demanded by the physician as 
well as the public, this demand will 
be met by an alert and concerned 
pharmaceutical industry. 

From my experience, my 
impression is that sectors of the 
pharmaceutical industry are indeed 
ethical. I challenge the industry as 
a whole to live up to that word in its 
finest sense. 


Pharmaceutical 
Manufacturers Association 
11 55 Fifteenth Street, N.W. 
Washington, D. C. 20005 



for September, 1974 


195 



ILLINOIS \ 
HOUSESTAFF 
NEWS 


Replacing the Doctor Draft 

By Michael Hughey, M.D. 


The " Housestaff Neu>s” is designed for interns and residents. Neius items and short articles of 
interest to housestaff will he considered for publication; materials should he sent to Michael 
Hughey, M.D., 711 Laurel Avenue, Wilmette, III. 60091. 


In recent years, the armed forces have relied 
upon the “doctor draft” and the draft-induced 
participants in the Berry Plan to provide medical 
officers for the different service departments. 
With the expiration of the draft, the Department 
of Defense estimates a physician shortage of 800 
by the summer of 1975 and 1800 by 1976. 1 With 
this shortage in mind, several new programs have 
been instituted in an attempt to attract more 
volunteer physicians into the armed forces. It is 
the hope of the Department of Defense that these 
programs will be operational by the time the cur- 
rent pool of physicians with previous commit- 
ments to the armed forces is exhausted. 

In the past years, a limited number of full 
scholarships have been offered to medical stu- 
dent by the armed forces. Part of Public Law 92- 
426 provides for expansion of this program. 2 Cur- 
rently, the Secretary of Defense is authorized to 
offer 5,000 of these scholarships to students at- 
tending medical, dental or any other health 
profession school located in the United States or 
Puerto Rico. Students participating in this pro- 
gram are given the rank of 2nd lieutenant or en- 
sign and are paid a stipend of $400 per month 
while in school. In addition, all tuition, books, 
fees, laboratory expenses and other educational 
expenses are paid, except for room and board. 

In return for the scholarship, participants are 
obligated to serve in the military on active duty 
the same number of years as they have partici- 
pated in the scholarship program. Taking a 
mi'itary residency is considered educational and 
does not count toward the active duty require- 
ment. It does not, however, add additional active 
duty obligation. 

In an effort to keep military physicians in the 
armed forces, an incentive pay plan is currently 
under consideration in Congress. As early as 
1947, it became clear that special pay rates were 
necessary to keep older, experienced military phy- 
sicians in the armed forces. At that time, the first 


of a series of special pay bonuses were offered to 
physicians who intended to make a career in the 
military. Currently, physicians who have served 
on active duty for more than two years are 
eligible for an additional $150 per month above 
their normal pay rate. The new bill in Congress 
would raise this special pay to $350 per month, 
an increase of $2400 a year. 

In addition, selected medical officers who have 
served on active duty for more than four years 
and who agree to continue on active duty for a 
variable number of years will be elegible for 
“incentive pay.” This incentive pay will vary 
according to individual circumstances, but may 
lie as great as $13,500 per year in addition to the 
normal officer’s salary. It is hoped that the com- 
bination of these two bonus pay programs will 
make a career in the Armed Forces financially 
more competitive with private practice. 

Perhaps the most interesting program designed 
to provide the armed forces with physicians is 
the Uniformed Services University of the Health 
Sciences (USUHS) . The USUHS, created in 1972 
by Congress, 3 will graduate a minimum of 100 
medical students annually by 1982. These physi- 
cians will have a seven year obligation to the 
Armed Forces, not counting internship and resi- 
dency. The purpose of the University is to pro- 
vide the armed forces with career officers in medi- 
cine, dentistry, and the allied health professions. 

Clinical training will be provided at the Na- 
tional Naval Medical Center in Bethesda, Walter 
Reed Army Medical Center, and Malcolm Grow 
Air Force Hospital. According to Congressman 
Samuel H. Young (10th District, 111.), the “na- 
tional medical school” is expected to be located 
at Walter Reed Army Medical Center and be 
“in operation by 1978.” 4 However, the develop- 
ment of an interim facility is also being consid- 
ered which could start a smaller class of medical 
students within the next two years. 

(Continued on page 222) 


196 


Illinois Medical Journal 


Report on Legislation 


An attempt to prevent chaos and confusion in 
physician licensure, and modification of various 
state health agencies are the thrust of five major 
bills enacted by the 78th General Assembly. 

During its recent session, the General Assembly 
acted to: prevent home-rule licensure of physi- 
cians; exclude physicians offices from “certificate 
of need’’ controls; assimilate Illinois residents 
who attended foreign medical schools into the 
state’s medical care system; improve mental 
health programs, and establish a Dangerous 
Drugs Commission which will supervise the 
state’s programs to treat drug abusers. 

The proposal establishing a state drug commis- 
sion has been signed into law; the four other bills 
await action by Governor Walker. 

Nine other major health-orientecl bills failed to 
pass, but are expected to be reintroduced in 
January. They included proposals to: amend 
the Blue Shield Law equating chiropractors with 
doctors of medicine and osteopathy; repeal the 
state’s anti-substitution law; create two new state 
agencies with broad powers in the health field, 
and strengthen the state’s medical disciplinary 
system. 

Health was an important topic in the legisla- 
ture this election year. Of the 1,260 measures 
considered, approximately 179— or one in six- 
concerned medicine. 

The effectiveness of ISMS in influencing the 
legislative process largely can be attributed to the 
valuable help provided by the many physicians 
who participated in the Key-Man Program, and 
others who worked with various ISMS commit- 
tees and staff. 

Physicians had a voice in the legislative areqa 
by providing expert testimony on various bills, 
and by phoning, wiring and writing their legis- 
lators to express their views on specific proposals. 

The following analysis is presented to give you 
a general view of major health-oriented proposals 
which were acted upon during the 78th General 
Assembly. For further information on these or 
any other proposals, contact the ISMS Govern- 
mental Affairs Division. 

MDs Excluded From 
‘Certificate of Need’ Controls 

Plans to build, expand, move or sell a hospi- 
tal, nursing home or surgicenter will require ap- 
proval of the State Comprehensive Health Plan- 
ning (CHP) Agency under S.B. 1609 which 
has been signed into law by Gov. Walker. 

A provision in the original bill which would 
have brought physicians’ offices and clinics under 
“certificate of need” regulation was withdrawn 


because of vigorous ISMS opposition. 

The new law covers construction or modifica- 
tion plans involving an expenditure of more 
than $100,000, or a substantial change in services 
or bed capacity. In effect, facilities covered by 
the “certificate of need” umbrella will be shifted 
into a semi-public utility status. 

Under S.B. 1609, local CHP agencies will hold 
public hearings on all applications for construc- 
tion or expansion before submitting a recommen- 
dation to the state CHP board for final action. 
The State CHP agency will be required to study: 
(1) area size; (2) population and growth poten- 
tial; (3) number of existing and planned facili- 
ties offering similar services; (4) utilization of 
existing facilities and (5) availability of alter- 
native facilities and services before granting ap- 
proval. 

Physicians can play a significant role in the 
decision-making process through involvement 
with local CHP agency committees, and by par- 
ticipating in public hearings held to review ap- 
plications. 

Authority of Mental Health 
Department Checked 

The authority of the Illinois Department of 
Mental Health to close state mental facilities or 
significantly alter programs may be sharply 
checked by a proposal now awaiting action by 
Governor Walker. 

H.B. 2710 calls for amendment of the act codi- 
fying IDMH powers and duties, and may force 
the Department to conduct public hearings and 
furnish the General Assembly with 240-days no- 
tice before undertaking any major action. The 
measure also directs IDMH to evaluate com- 
munity needs and consider community opinions 
regarding any proposed program changes. 

H.B. 2710 is a combination of two other pro- 
posals introduced during the session, both clearly 
reflecting discontent with IDMH policies, and 
concern that these policies often were not in the 
best interests of the patients and communities in- 
volved. 

Dangerous Drugs Commission Formed 

Some specific functions of several state agen- 
cies— including the Dangerous Drugs Advisory 
Council— have been consolidated under a Dan- 
gerous Drugs Commission (DDC) which will 
direct the state’s programs to treat and rehabili- 
tate drug abusers. 

Governor Walker already has signed H.B. 2826 
creatine the DDC which will monitor education- 

o 

al programs, disburse grants, license facilities to 


fur September, 1974 


197 


carry out drug treatment programs and serve as 
the review body for scheduling controlled sub- 
stances. The DDC also will plan new programs 
and evaluate current services in an effort to up- 
grade treatment. 

The proposal received strong backing from 
ISMS because of the need to coordinate and stab- 
ilize rehabilitation techniques and services. Un- 
der the DDC, local programs will be freed of 
many coordination responsibilities and all owed 
to concentrate on providing treatment. 

Ease Road Into Illinois 
Medicine For FMGs 

Obtaining a license to practice in Illinois may 
be, temporarily at least, easier for Illinois-born 
foreign medical graduates (FMGs) . 

Under two bills passed by the General As- 
sembly and now awaiting action by the Gov- 
ernor, a state-financed clinical training program 
should encourage these FMGs to practice in Illi- 
nois. 

S.B. 1621 amends the Medical Practice Act and 
allows Illinois-born FMGs to enroll in a super- 
vised clinical training program at an Illinois 
medical school provided they pass an equivalency 
test. Following completion of the course, the 
FMG is eligible to take another examination 
which— if he passes— will certify his training as 
comparable to that provided in U.S. medical 
schools. He then may take the state licensure 
examination. 

The bill also allows an Illinois-born FMG who 
has completed a “fifth pathway” program in an- 
other state to take the Illinois licensure exam- 
ination. The proposal is experimental, however, 
and automatically will be repealed after four 
years. 

A second proposal, S.B. 1620, earmarks $60,000 
to support the training programs. Exactly how 
the fund swill be distributed among the state’s 
medical schools has not been decided. 

Licensure by Home-Rule Units Blocked 

Home-rule units may be denied the power to 
license physicians, and the state would retain its 
exclusive licensure authority, if Govenor Walker 
signs S.B. 1504. 

The proposal is a move to prevent local licen- 
sure for revenue, and to avoid the tremendous 
confusion which would result if every home-rule 
unit established its own licensing standards and 
procedures. 

S.B. 1504 is one of approximately 30 measures 
dealing with the authority to license various pro- 
fessions which was considered during the past 
session. 

The battle to prevent home-rule units from 
licensing professionals already licensed by the 


state began in 1971 when the new State Consti- 
tution was ratified. The Constitution contained 
strong home-rule provisions which granted new 
powers to cities of 25,000 population or more 
and Cook County. Under the old State Constitu- 
tion, cities and all other units of local govern- 
ment could exercise only those specific powers 
granted by the legislature. 

The battle appeared to end two years ago, 
however, with the passage of H.B. 3636 which 
denied home-rule licensing authority. Unfor- 
tunately, the Illinois Supreme Court ruled the 
law unconstitutional and resurrected the pros- 
pect of chaos in licensure functions. 

Regulate HMO Development, Services 

A nine-member Health Maintenance Advisory 
Board within the Illinois Department of Public 
Health (IDPH) will develop standards govern- 
ing the quality of services provided by Health 
Maintenance Organizations (HMOs) . 

Under S.B. 1128— already signed by Governor 
Walker— IDPH also will evaluate an HMO ap- 
plicant’s ability to meet these standards and 
refer its findings to the Illinois Department of 
Insurance which grants HMO certification. In 
addition, IDPH is required to conduct annual 
reviews of HMO services. 

Other Action by the General Assembly 

Among the health-oriented bills that were not 
passed— but may be reintroduced in January— 
are proposals which would: 

Super Agency (S.B. 955) : Consolidate the 
Departments of Public and Mental Health, Pub- 
lic Aid, Children and Family Services and others 
into a State Department of Health and Social 
Services, or “super agency.” ISMS opposed this 
proposal, contending that IDPH should remain 
a separate agency. Referred to House Rules Com- 
mittee. 

Repeal Anti-Substitution (H.B. 2136 & 

2137) : Abolish the existing anti-substitution 
law and allow pharmacists to substitute generic 
equivalents unless the physician specifically pro- 
hibits the practice in writing. ISMS vigorously 
opposed both measures. Assigned to House Rules 
Committee. 

Medical Disciplinary System (H.B. 2886, 
2887 & 2888) : Create a disciplinary system to 
investigate charges of misconduct or incompe- 
tence against doctors of medicine and osteopathy, 
and chiropractors. These three measures were 
developed by ISMS. Under study by House Rules 
Committee. 

Chiropractic (S.B. 910) : Amend the Blue 
Shield Law and equate chiropractors with doc- 
tors of medicine and osteopathy. Opposed by 
( Continued on page 22-1) 


198 


Illinois Medical Journal 


'Dacfo'i 4 

“TAP INSTITUTE” SLATED FOR OCTOBER-The Illinois State Medical Society and the 
Illinois Hospital Association are co-sponsoring a “Trustee-Administrator- 
Physician (TAP) Institute,” October 4-5, 1974, at 0‘Hare Regency Hyatt 
House, Chicago. This institute is designed to help participants develop and 
implement effective internal programs to assure the quality of care within 
the hospital. For further information, contact Gaylen Newmark, IHA, 840 
N. Lake Shore Drive, Chicago; phone (312) 664-9500. 

CONFERENCE ON DRUG AND ALCOHOL TO BE HELD DOWNSTATE-The Illinois 
State Medical Society and the McLean County Medical Society, will spon- 
sor a two-day workshop/conference on drug and alcohol dependencies, 
October 4-5, 1974, in Bloomington-Normal. The conference will have em- 
phasis on the latest methods of combating drug and alcohol abuse; an 
outline of the functions of the two new state agencies dealing with drug 
abuse and alcohol; and an in-depth look at the Illinois Dangerous Drugs 
Commission and the Illinois State Plan for Prevention Treatment and Con- 
trol of Alcoholism. 

The free clinic approach to drug abuse will be discussed by George R. 
Gay, M.D., Clinical Director of the Haight Ashbury Free Medical Clinic, 
San Francisco. 

For further information and advanced registration, contact Albert W. 
Ray, Jr., M.D., ISMS, 360 N. Michigan Ave., Chicago, 60601; (312) 782-1654. 

ISMS STATE FAIR HYPERTENSION SCREENING SUCCESSFUL An average of 1054 peo- 
ple per day registered and had their blood pressure taken at the State Medi- 
cal Society’s screening project at the 1974 Illinois State Fair. 

Featured for 1973 and 1974 in the Society’s Grand Stand exhibit space 
(for the 26th consecutive year) was a Blood Pressure Center, which had 
been especially built by Ciba Pharmaceuticals for their nationwide CHEC 
program. For the 1974 project this sectionalized unit was permanently 
donated by Ciba to the Illinois State Medical Society. It has been recently 
learned that one of the reasons for this gift was the excellence of the screen- 
ing program conducted by the State Society in 1973. 

Organized and managed by the ISMS, the 1974 project was staffed for 
seven days by members of the Respiratory Therapy Department and for 
two days by members of the Division of Nephrology, both of Memorial 
Medical Center, Springfield. 

AMA CHIEF PRAISES Your Personal Learning Plan — William R. Barclay, M.D., Assistant Ex- 
ecutive Vice-President of AMA, recently saw Your Pearsonal Learning Plan 
for the first time, and wrote about it: . . an extremely useful booklet which 

could help any physician irrespective of his type of medical practice to 
upgrade his skills and to keep abreast of current developments. Ideally, all 
physicians should have a copy ... to help them organize their CME.” 

Do YOU have a copy yet? Over 5,000 have been distributed since publi- 
cation a year ago— about half at $l/copy to physicians outside Illinois. That 
means several thousand Illinois physicians— who may have a copy free— 
haven’t yet requested one. 

To get YOUR free copy, just write “Personal Learning Plan” on your 
prescription form, and mail to: Illinois Council on Continuing Medical 
Education, 360 N. Michigan Ave., Chicago, IL 60601. 


for September, 1974 


199 


DR. LAKE MAKING STATE TOUR— Fredric D. Lake, M.D., President, Illinois State Medi- 
cal Society, has started his President’s Tour. Dr. Lake will attend the follow- 
ing county medical society meetings during 1974-1975: 


September 10 
September 18 
October 8 
November 12 
November 14 
November 21 
November 26 
January 8 
January 14 
February 6 


Sangamon 
DuPage 
Rock Island 
Lake 

Champaign 

LaSalle 

Macon 

Will-Grundy 

Winnebago 

North Side Branch, CMS 


PHYSICIANS IN THE NEWS— The Chicago Medical School has named five new acting de- 
partment chairmen; they are: Peter Altner, M.D., Department of Surgery; 
Lester Cohen, M.D., Department of Medicine; John Keller, M.D., Depart- 
ment of Obstetrics and Gynecology; Agnes Lattimer, M.D., Department of 
Pediatrics; and Melvin Thorner, M.D., Department of Neurology. 

George A. Wiltraikis, M.D., Past President of Kane Medical Society, was 
recently elected national Surgeon General of the Veterans of Foreign Wars. 


HAND SURGERY COURSE PLANNED-Robert A. Schenck, M.D., Director, Section of Hand 
Surgery and Assistant Professor, Departments of Plastic and Orthopedic 
Surgery, Rush-Presbyterian-St. Luke’s Medical Center, will conduct the 
Second Annual Course in Hand Surgery. 

The course will meet each Wednesday evening from 6-7 p.m. at the A. B. 
Dick Auditorium, RPSL Medical Center, 1753 W. Congress Parkway; 
Subjects to be presented and dates are: 

Functional Anatomy of the Hand, Sept. 11 
Flexor Tendon Surgery, Sept. 18 
Extensor Tendon Surgery, Sept. 25 
Flaps, Nerve Repair, Dressings, Oct. 2 
Bone, Joint and Rheumatoid, Oct. 9 
For information, contact Dr. Schenck, M.D., (312) 848-7773. 

“Clarence Monroe Day” Honors 
Retiring Plastic Surgeons 

Clarence Monroe, M.D., Oak Park, was recently hon- 
ored by the Chicago Society of Plastic Surgery with 
“Clarence Monroe Day” which featured scientific meet- 
ings and dinner to commemorate the retirement of the 
plastic surgeon. 

Dr. Monroe, a graduate of Rush Medical College, has 
been Chief, Plastic Surgeon Section, Division of Surgery, 
at Children’s Memorial Hospital since 1953. Since 1966, 
Dr. Monroe has done extensive research in the clinical 
study of bone grafting in the repair of clefts of the 
alveolar ridge in cleft palate children. 

He is Past President of the American Association of 
Plastic Surgeons, Midwestern Association of Plastic Sur- 
geons and the Chicago Society of Plastic Surgery. Dr. 
Monroe is a member of the Illinois State Medical Society 
and is Board Certified by the American Board of Gen- 
eral Surgery and American Board of Plastic Surgery. 



Clarence Monroe 


200 


Illinois Medical Journal 



Editorials 


r II 

L. A 


Immunization Action Month 


The recurrent problem of measles in Illinois 
during the past few years is a cause of great con- 
cern. We should be making every possible effort 
to diminish the relatively high incidence of this 
preventable disease. In 1973, a total of 2,162 cases 
of measles were reported in Illinois, and in that 
same year Illinois had the dubious distinction of 
ranking third among the 50 states in the reported 
number of measles cases. 

During the first six months of 1974, a total of 
1,744 cases of measles have been reported in Illi- 
nois, and at least one death has been attributed 
to the disease. Individual investigations of 681 
downstate cases have been completed by local 
health departments or Illinois Immunization Pro- 
gram personnel. It was found that 51% of these 
cases occurred in unvaccinated persons, and 33% 
occurred in persons who were incorrectly vac- 
cinated. Only 11% had a record of having been 
correctly immunized. The immunization history 
of the remaining 5% was unknown. These re- 
sults, like those reported from other areas, indi- 
cate that the cause of the persistence of measles 
is inadequate use of vaccine. 

Joyce Lashof, M.D., Director of the Illinois De- 
partment of Public Health, stated, in a letter 
written to ISMS, “We are determined to raise 
measles immunization levels significantly in Illi- 
nois, and committed to increased efforts toward 
this end during the coming year.” 


However, measles is not the only immuniza- 
tion problem in Illinois. Although it is the most 
severe in terms of number of reported cases, the 
immunization levels against polio are even lower 
than the measles immunity levels. 

During October, Illinois will participate in Im- 
munization Action Month, a national campaign 
organized by the Center for Disease Control in 
Atlanta, Georgia. As a part of this program, So- 
ciety members who are in appropriate specialties 
or family practice should utilize the "Immuniza- 
tion Audit Forms.” These forms can be attached 
to patients’ records and used as a reminder when 
immunizations are needed. These forms should 
be of assistance in alterting the physician to 
children who have immunization needs and are 
available from IDPH in Springfield. 

Members are reminded of the importance of 
reporting cases of measles, rubella and polio to 
the state health department. Any physician who 
does not have a supply of the necessary report 
forms, may obtain them from the Illinois Depart- 
ment of Public Health. 

With continuing cooperation between the So- 
ciety and the state health department, we can 
eventually preclude the need for outbreak con- 
trol measures by ensuring that each child receives 
needed immunization at the earliest indicated 
time. 

T. R. Van Dellen, M.D. 

Editor 


Note: See special article, October Is Immunization Month, page 20S 


for September, 1974 


201 


The more physicians 
consider the hemodynamics of 
lowering blood pressure... 


Most physicians now agree on 
the importance of reducing 
blood pressure in the hyper- 
tensive patient. But high blood 
pressure exists, of course, only 
as part of a complete clinical 
picture. The hemodynamic 
profile of well-established es- 
sential hypertension is charac- 
terized by elevated arterial 
blood pressure, normal cardiac 
output, and increased total 
peripheral resistance. 

And so, physicians are increas- 
ingly concerned with the ef- 
fects of an antihypertensive 
agent not only on blood pres- 


sure itself but also on the 
hemodynamic pattern — in 
short, with the total effect of 
the drug. Does it indeed help 
lower blood pressure effec- 
tively? Is peripheral resistance 
reduced? Are cardiac output 
and renal functions main- 



tained? And, also, is there 
likely to be drug-induced pos- 
tural hypotension serious 
enough to pose a threat to the 
patient’s cerebrovascular 
status? 

With this emphasis on overall 
drug performance has come a 
growing reliance on ALDOMET® 
(Methyldopa, MSD) in the 
treatment of sustained moder- 
ate hypertension. 

With its unique hemodynamic 
profile, ALDOMET has drawn 
increasing attention and ap- 
proval from physicians. First, 
of course, for its efficacy in 



Surgical Grand Round are held weekly on Tuesday at 5:00 p.m. in the Offield 
Auditorium of Northwestern Memorial Hospital. Patient presentations from 
Passavant and Wesley Pavilions and the Veterans Administration Research Hos- 
pitals form the basis of the discussions. This case report was part of the Surgical 
Grand Rounds of September 5, 1972. 


Renal Tumor 


Dr. Edward Kapustka: A 50-year-old white 
woman came to the Passavant Emergency Room 
with a history of lower abdominal discomfort, 
hematuria with slight dysuria but without fre- 
quency of 36 hours duration. A few hours before 
she entered the Emergency Room she had a 
tremendous urge to void but had been unable to 
urinate. In the Emergency Room when she was 
examined, her bladder was not found to be dis- 
tended; however, a catheter was inserted and a 
moderate amount of bloody urine was obtained. 
She was admitted to the hospital and Gantrisin® 
was prescribed. Urinalysis at the time of admis- 
sion showed numerous red blood cells and a few 
white cells. 

Past medical history: She had a right ureteral 
calculus in 1958. Her family history was sig- 
nificant because both her mother and foster 
father had died of carcinoma of the kidney. 
Physical examination revealed palpable, slightly 
tender right kidney with the lower border at the 
level of the iliac crest but apparently normal in 
size and shape. Other organs or masses were not 
felt. Laboratory findings were: hemoglobin/13.7, 
hematocrit/43%, BUN/8mqn, creatine/1.1 mqn 
and creatine clearance/78 cc per minute. An 
intravenous pyelography was performed prior 
to cystoscopy. 

Dr. Earl Nudelman: The intravenous pyelogram 
shows that there is ptosis and rotation of the 
right kidney which in many cases is the reason 
why the right kidney is palpable. There is an 
area of relative radiolucency in the lower pole 
of the kidney. There is a space occupied in the 
lower pole of the right kidney which, at this 
point, would most likely be a cyst, (Figure 1). 



Figure 1. Intravenous pyelogram demonstrated dis- 
tortion of calyceal system of the right kidney, sug- 
gesting a cystic lesion of the lower pole. 


Dr. Kapustka: Cystoscopy demonstrated no evi- 
dence of neoplasm. Because a mass lesion was 
present in the right kidney, aortography was per- 
formed. 

Dr. Nudelman: This lady has an unusual con- 
figuration of the aorta, with sharp angulation. 
The vessel supplying the upper pole was selec- 
tively studied and its branches are normal, (Fig- 
ure 2) . The vessel to the lower pole, the area of 


for September, 1974 


205 



Figure 2. Selective arteriogram shows a normal up- 
per pole of the right kidney. 



Figure 3. Aortogram demonstrated a tortuous aorta 
hut there was no evidence of a tumor “blush” in the 
lower portion of the right kidney. 


interest, could not be selectively catheterized. On 
the studies that we have, there is no evidence of 
tumor vascularity, (Figure S) . No tumor vas- 
cularity is identified in the lower pole area, but 
without a selective study the examination would 
have to be considered incomplete. 

Dr. Kapustka: This presentation demonstrates 
the difficulty in differentiation between renal 
tumors and renal cysts radiographically. This pa- 
tient had a mass lesion in her kidney which most 
of us thought was a cyst. The problem was pre- 
sented to the patient. Because neoplasm could 
not be excluded, the patient accepted explora- 
tion for a definitive diagnosis. A right flank in- 
cision was made. When the kidney was exposed, 
a cystic lesion was found in the location that was 
visualized on the tomogram. However, the lesion 
did not appear to be a typical serous cyst of the 
kidney. The wall was thicker and slightly whit- 
ish, and there was some slight increased vascular- 
ity of the cyst wall. Because the cyst appeared 
unusual and a tumor might be present, a radical 
nephrectomy was performed without opening 
the cyst. 

Dr. Hector Battifora: The kidney which was 
sectioned, lias a tumor about 5 cm in maximum 
diameter, (Figure 4). It is a peculiar type of 
tumor because it has a solid portion and a cystic 
component. The renal pelvis is not involved by 
the tumor, and so were the vein, artery and the 
ureter. Two histological patterns could be dis- 
cerned. The first was the classical clear cell type 
or hypernephroma type pattern, (Figure 5) . The 
second was made up of extremely well differen- 
tiated cells forming tubule-like structures. In 
these, apical thickening of the cytoplasm in the 
manner of brush borders could be seen. Brush 
borders have been demonstrated by electron 



Figure 4. Cross section of removed kidney showed 
cystic neoplasm in lower pole. 


206 


Illinois Medical Journal 



Figure 5. Typical clear-cell pattern was found with 
microscopic examination. 


microscopy in well differentiated renal cell car- 
cinoma, thus proving the tubular epithelial his- 
togenesis and laying to rest the adrenal rest 
theory. Therefore, this is a very well differen- 
tiated adenocarcinoma of the kidney which, for 
some reason, also has a cystic portion. Whether 
this cystic portion is due to necrosis of pre-ex- 
istent tumor, or to actual accumulation of secre- 
tions, is uncertain. 

Dr. Kapustka: Renal cell carcinoma is seen 
twice as frequently in men as women. As the 
average age of 58 indicates, it is a disease of later 
life. Currently, the classic triad of gross hema- 
turia, of palpable flank mass, and pain, is ob- 
served infrequently in patients with renal car- 
cinoma. In a recent review of 400 patients, 58% 
had no urinary symptoms; gross or microscopic 
hematuria was noted in only 32% of the patients. 
Flank pain was present in 24%, weight loss in 
22%, and a palpable mass in 34%. Renal cell 
carcinoma can be very insidious. Many patients 
we see present with metastasis. The diagnostic 
studies will be discussed later. The treatment is 
basically nephrectomy. As time goes on, a simple 
nephrectomy has evolved into a more radical 
procedure which involves taking the perirenal 
fat, and the paracaval nodes. Unfortunately, in 
this case we did not secure the vascular pedicle 
prior to manipulation of the kidney because our 
preoperative studies suggested the mass present 
was avascular and probably a cyst. Despite this, 
the mass was exposed with sharp dissection and 
a decision was made to remove the kidney on the 
basis of its gross appearance. The major vessels 
were isolated and secured individually and the 
perirenal fat with Gerota’s fascia removed. The 
fat and nodes along the great vessels were re- 
moved; the adrenal was not, since the tumor was 
in the lower half of the kidney. 

The survival for patients with renal cell car- 


cinoma subjected to nephrectomy approximates 
40-45% for five years. Dr. Robson of Toronto, a 
strong advocate of node dissection, has noted 
significantly higher 5 year survivals. However, his 
patients have a very careful preoperative evalua- 
tion including chest laminagrams, node biopsy, 
and even mediastinoscopy in an attempt to iden- 
tify patients with disseminated disease. Some 
patients with metastatic carcinoma of the kidney 
have prolonged survivals. In a group of 93 pa- 
tients subjected to nephrectomy despite dis- 
seminated disease, 14% survived 5 years and 
some, about 6%, went on to a 10 to 15 year sur- 
vival. Perhaps these patients somehow altered 
their immune mechanism and were able to sur- 
vive much longer. Patients with renal cell car- 
cinoma are recognized to experience spontaneous 
regression of the tumor. The exact mechanism of 
this is not understood. 

Dr. John Gravliack: This patient is of interest 
from the standpoint of the etiology of her tumor. 
Her mother and foster father died from car- 
cinoma of the kidneys and now she has an 
unusual carcinoma of the kidney. No hereditary 
basis for carcinoma of the kidney has been recog- 
nized, but in the July, 1972, Journal of Urology, 
five siblings with bilateral carcinoma of the kid- 
ney were reported. This is the most striking ob- 
servation of a familial incidence of this lesion 
although parent-sibling and sibling-sibling oc- 
currences have beexr reported before. So has an 
association with Lindau’s disease. A practical 
question raised by the mother-daughter incidence 
of renal neoplasm concerns the extent to which 
other family members should be surveyed; a 
reasonable case could be made for pyelographic 
screening. 

The other point of concern is the attempt to 
make a definite histologic diagnosis by X-ray 
studies. These studies in this patient disclosed an 
avascular mass characteristic of a cyst. Although 
the X-ray studies wexe not the usual high qual- 
ity demonstration we have come to expect from 
Dr. Nudelman because of technical difficulties, 
even ideal radiographic studies have a recognized 
fallability in our experience and that of others. 
The Cleveland Cliixic, recognized for the excel- 
lence of its angiographic efforts, recently reported 
10 errors iix 90 patients with inaligixancy. X-ray 
studies may demonstrate a probable avascular 
ixxass which is very likely but not certainly non- 
malignaxrt. It is our practice to recommend ex- 
ploration of patients with renal masses. That is 
what we recommended to this patient, although 
we did tell her that there was at least a 95% 
(Continued on page 226) 


for September, 1974 


207 


October Is Immunization Action 

Month 

By Joyce C. Lashof, M.D., Director, Illinois Department of Public Health/Springfield 


During October, Illinois will participate in 
Immunization Action Month, a national effort 
to reverse the trend of declining immunization 
levels, especially among the one-to-four-year age 
group, 4 hese levels have been decreasing at an 
alarming rate during the past few years. 

I he recurrent problem of measles in Illinois 
is of special concern. The continuing relatively 
high incidence of this preventable disease is 
shown in the following: 


Measles Incidence 
By Age Group 
State of Illinois 
1971 - June 30, 1974 




AGE GROUP 


Total 

Year 

1 

1-4 

5-9 

10 + 

Unknown 

Cases 

1971 

141 

428 

1,898 

745 

248 

3,460 

1972 

365 

768 

2,065 

1,004 

452 

4,654 

1973 

372 

568 

766 

373 

83 

2,162 

1974 

140 

326 

638 

425 

215 

1,744 


At least one death was attributable to measles 
during the first half of 1974. In 1972, Illinois 
ranked first among the 50 states in reported 
number of measles cases. We were third in 
1973, and we are in third place through the 
end of June of this year. 

A comparison of change in the clownstate 
measles incidence with that of Chicago may 
be of interest: 


Period Change Downstate 

1972 vs. 1971 11% 

1973 vs. 1972 66% 

5/31/74 vs. same 

week of 1973 15% 


Change Chicago 
191% 

22 % 

48% 


Of the 932 cases reported downstate as of 
May 31, 1974, 70% (679) have come from eight 
counties in the northeast section of the state. 

In 1974, 65% of the reported measles inci- 
dence, downstate, has occurred in the 5-14-year 
age group, the mean age being about seven years. 
This was also the case in 1972 and 1973. 


Percentage Distribution of Measles Cases 
Bv Age Category for Downstate and Chicago 
January 1 - May 31, 1974 


Age Group 

Downstate 

Chicago 

1 

2 

22 

1-4 

10 

54 

5-9 

44 

16 

10-14 

21 

6 

15 + 

6 

2 

Unknown 

17 


TOTAL 

100% 

100% 


Personnel of either local health departments 
or the Illinois Immunization Program have com- 
pleted individual investigations of 681 (73%) 
of the 932 downstate cases reported in the first 
five months of this year. It was found that 51% 
of these cases occurred in unvaccinated persons, 
while 33% occurred in persons who were in- 
correctly vaccinated, e.g., persons who received 
vaccine under one year of age, or inactivated 
measles virus vaccine, or live further attenuated 
vaccine accompanied with gamma globulin. Only 
I 1 % had a record of having been correctly 
immunized, and for 5% the immunization his- 
tory was unknown. These results like those 
reported from other areas, indicate that the 
cause of the persistence of measles is inadequate 
use of vaccine. 

The Illinois Department of Public Health is 
determined to raise measles immunization levels 
significantly in Illinois, and is committed to in- 
creased efforts toward this end during the com- 
ing year. 

The state health department has routinely 
made immunization services available to all of 
the state’s 102 counties. These services include 
the provision of biologies to local health depart- 
ments, hospitals and participating private physi- 
cians to be administered, at no charge for the 
immunizing agent, to the public (primarily 12 
years of age and younger, at the earliest medical- 
ly indicated time) ; the assessment of immunity 


208 


Illinois Medical Journal 


levels; surveillance of incidence; educational and 
motivational activities; and assistance in con- 
ducting outbreak control measures. 

This year there will be special emphasis in 
several types of activities. During “Immunization 
Action Month,” the Illinois Department of Pub- 
lic Health will conduct a state-wide program to 
improve the immunization levels of pre-school- 
age children. As a part of this program, physi- 
cians in appropriate specialties or family practice 
are being urged to become aware of, and utilize, 
the “Immunization Audit Forms.” These forms 
are available from Lederle representatives, or 
from the state health department if your Lederle 
representative does not have them. The “Audit 
Forms” can be attached to patients’ records and 
used as a reminder to the physician that im- 
munizations are— or soon will be— needed. In 
addition, the Illinois Department of Public 
Health is working with the Office of the Superin- 
tendent of Public Instruction in a program to 
improve compliance with the requirements of 
the School Code as they pertain to immuniza- 
tion. 

One of the most important parts of the state’s 
increased effort will be to provide for any neces- 
sary outbreak control measures, including pro- 
moting and conducting special emergency clinics 
when warranted. This activity has been included 
because, if measles is to be eradicated, or even 
reduced and maintained at a low incidence, ap- 
propriate emergency measures must be taken to 
contain outbreaks at the earliest time before 
they develop into epidemics. 

And measles is not the only immunization 
problem in Illinois today. Although it is the 
most severe in terms of number of reported 
cases, the immunization levels against polio, for 
example, are lower than the measles immunity 
levels. 

According to data from the 1973 National 
Immunization Survey, and from surveys con- 
ducted by the Illinois Immunization Program 
and the Chicago Board of Health, the present 
percentages of immunity are as follows: 


DOWNSTATE ILLINOIS (As of June 30, 1974) 


Age Group 


Disease Type 

1-4 

5-12 

Measles 

“62" 

80 

Rubella 

61 

79 

Poliomyelitis 

58 

76 

DPT/Td 

72 

86 


CHICAGO (As of June 30, 1973) 



Socioeconomic 


Age 


Status 

1-4 

5-9 

Measles 

Lower 

75.8 

95.1 


Middle 

78.2 

96.9 


Upper 

90.9 

97.6 

Rubella 

Lower 

51.6 

66.9 


Middle 

63.4 

83.6 


Upper 

83.8 

91.2 

DPT/=^3 

Lower 

64.8 

89.5 


Middle 

79.2 

93.8 


Upper 

90.9 

100.0 

Polio 

Lower 

56.0 

84.4 


Middle 

78.2 

90.6 


Upper 

89.9 

97.6 


Ideally, people should utilize existing health 
services, private and public, in their communi- 
ties, and immunizations should be part of a 
complete health care program performed under 
normal conditions. However, in the event of an 
outbreak, more must be done than merely advis- 
ing people what services exist. Often routine 
services are inadequate to handle the problem 
expeditiously. Even when routine services are 
available, an outbreak is an indication that too 
many persons in the community, particularly 
the parents of young children, have not utilized 
them, and many children have been left un- 
protected. This, in turn, means that the im- 
mediate problem must be attacked on an emer- 
gency basis. Subsequent efforts can then be 
directed toward motivating routine immuniza- 
tions through normal services. 

The present policy of the Illinois Department 
of Public Health is to initiate emergency mea- 
sures within 24 hours of the time that five or 
more cases of measles are found to exist and 
to be related epidemiologically. These outbreak 
control measures should include community-wide 
notices stating the problem and, usually, special 
clinics conducted around the outbreak to abort 
second or third generation cases. Appropriate 
vaccines, jet injector immunization equipment 
and available j^ersonnel will be provided by the 
state health department’s Immuniztion Program 
to assist in these efforts. Local authorities have 
the primary responsibility to initiate outbreak 
control measures, and, preferably, this should 
be done with the knowledge, cooperation and 
support of the local medical society. 

Experience has demonstrated that, when nec- 
essary, immunizations can be effectively admin- 
istered with a high degree of safety in special 
public clinics. The success of such activities are 
(Continued on page 223) 


tor September, 1974 


209 


(Continued from page 175) 

Neurosurgeons on Affiliate Society Council 

The Board approved representation of the Illinois Neurosurgical Society on the 
ISMS Council on Affiliate Societies upon its organization this fall. INS is 
the Illinois Section of the Central Neurosurgical Society. 

Hospitals and HMO’s 

In response to an Illinois Physicians Union request for a position statement on 
hospitals which establish Health Maintenance Organizations unilaterally with- 
out approval of their medical staff, the Board said that-in matters pertaining 
to the practice of medicine-it opposes any unilateral action by the hospital ad- 
ministration. 

TAP Institute 

ISMS will join the Illinois Hospital Association in sponsoring a Trustee-Ad- 
ministrator-Physician Institute October 4-5, 1974, at the Regency Hyatt House in 
Chicago. The institute is conducted by the Joint Commission on Accreditation of 
Hospitals. 

Illinois Conference on School Health 

ISMS will co-sponsor the 8th Illinois Conference on School Health December 5, 
1974, with $300 being pledged to cover expenses. Richard Dukes, M.D. , Urbana, 
ISMS representative to the Joint Committee on School Health, will deliver the 
welcome address and Willard Fullerton, M.D., Sparta, will be honored for his 
many years of service to the committee. 

Woman’s Auxiliary 

The Board referred to the Committee on Constitution and Bylaws a suggestion 
that the immediate past president of ISMS serve as the chairman of the Advisory 
Committee to the Woman’s Auxiliary. Present bylaws specify that the ISMS presi- 
dent-elect serve as chairman. 

Mileage Allowance 

Effective September 1, all officers, trustees, council and committee members 
and staff using their personal cars on society business will receive 15 cents 
mileage allowance. The rate has been 12-1/2 cents per mile. 

IDPA Review of Medicaid Physicians 

The Board referred to the Chicago Medical Society an Illinois Department of 
Public Aid request for assistance in recruiting competent physicians to perform 
on-site reviews of the quality of care rendered by high volume Medicaid physi- 
cians. The Board said that since most of the reviews are done in Cook County, it 
would be more appropriate for CMS to help IDPA recruit physicians for this work. 

ISMS to Move Headquarters 

The ISMS headquarters office, located at 360 N. Michigan, Chicago, since 1960, 
will be moved about December 1, 1974, to the 35th floor of the Mid-Continental 
Plaza, a new building located across from Chicago's Palmer House. The Illinois 
Foundation for Medical Care and the Illinois Council on Continuing Medical Edu- 
cation will share the space. 

Immunization Action Month 

At the request of Joyce Lashof, M.D. , Director of the Illinois Department of 
Public Health, the Board endorsed the department's plans for promoting Immuni- 
zation Action Month in October. Dr. Lashof reported that immunization of pre- 
school children has been lagging. 


210 


Illinois Medical Journal 


Revised Budget Approved 

The Board approved a revised budget for 1974 as presented by Mather Pfeiffen- 
berger, M.D., Chairman, Finance Committee. The revised budget anticipates in- 
creases in both receipts and expenditures. 

MEDICHEK 

As a followup to House of Delegates' action regarding payment of usual and cus- 
tomary fees under MEDICHEK, the Board directed the Relative Value Study Commit- 
tee to give priority to gathering data for use in constructing units for MEDI- 
CHEK services. This information will be referred to the Illinois Department of 
Public Aid for modification of its fee structure. In a related matter , the Board 
authorized expansion of the ISMS Government Health Program Workshops to include 
instructions regarding completion of MEDICHEK forms. The workshops have previ- 
ously been providing physicians' medical assistants with information on Medi- 
care, Medicaid and CHAMPUS forms. 

Quackery 

ISMS will encourage the National Institute of Health to utilize objective, 
scientific criteria in its study of the fundamentals of the chiropractic profes- 
sion. It has been reported that NIH's National Institute of Neurological Disease 
and Stroke has received a special grant for this purpose. 

Legislation 

ISMS will: (1) seek an amendatory veto of Section 1.5 of S.B. 1676 (Emergency 
Medical Services Act) to increase protection from liability for doctors , nurses, 
paramedics and hospitals ; (2) seek corrective legislation to modify the inspec- 
tion provisions delegated to the Dangerous Drugs Commission under H.B. 2826 ; (3) 
urge the Governor to sign S.B. 1500, which allows the Department of Mental Health 
additional time to replace the hospital permit system or prepare permit holders 
to qualify for license to practice medicine; (4) instruct legal counsel and the 
Governmental Affairs Council to prepare an in-depth analysis of S.B. 1625, the 
rate review bill; (5) seek re-introduction of H.B. 2886 and 2887, the medical 
disciplinary bills, and (6) oppose the amendatory veto of S.B. 1527, a home-rule 
exemption for sanitarians as requested by the Illinois Public Health Associa- 
tion and Illinois Environmental Health Association. 

Legislative Committee on Health 

ISMS will recommend to the new special sub committee of the House Human Re- 
sources Committee charged with reviewing national health legislation that it 
address three major federal proposals— nat ional health insurance, health plan- 
ning and health manpower. ISMS will closely monitor the sub committee's actions 
and whenever possible submit available information to insure that this commit- 
tee's recommendations result in meaningful legislation at the state level. 

Blood Pressure Screening by Blood Banks 

The Board of Trustees adopted a recommendation of the Laboratory Services 
Committee that ISMS not support the concept of having routine blood pressure 
screening accomplished by blood banks on a statewide basis since this is not 
part of the normal procedure and primary responsibility of a blood bank ; that 
any such screening be accomplished in keeping with the established ISMS policy; 
that it continue to be recognized that blood pressure is important and should be 
utilized as one of the many parameters within the responsibility of the physi- 
cian in screening for disease; that the Illinois Heart Association be encour- 
aged to continue in its commendable efforts to detect cardiac disease by provid- 
ing appropriate facilities and personnel to accomplish screening ; and that should 
local agencies wish to establish blood pressure screening programs through lo- 
cal blood banks, such be accomplished with the concurrence of the county medical 
society. 


for September, 1974 


211 


HCG Weight Clinics 

The Board will ask the Illinois Attorney-General and Department of Registra- 
tion and Education to investigate HCG weight control clinics for possible vio- 
lations of the Illinois Medical Practice Act and other laws. ISMS also will re- 
quest an official opinion from the AMA Judicial Council regarding the ethics of 
physician involvement with HCG weight clinics. These inquiries will be publi- 
cized in ACTION REPORT and special notification will be sent to those counties 
where such clinics are known to exist. 

Health Care for Spanish-Speaking Communities 

The Council on Social and Medical Services was authorized to proceed with 
plans for a Conference on Health Care in Spanish-Speaking Communities. It is con- 
templated that such a conference would be conducted in cooperation with the Il- 
linois Hospital Association and the appropriate county medical society. 

Medicare Reimbursement 

The Council on Mental Health and Addiction was requested to supply the Chairman 
of the Board of Trustees with specific information regarding the council's com- 
plaint that psychiatric services are being reimbursed under Medicare at less than 
other medical services so that appropriate objection can be made with HEW and the 
Social Security Administration. Copies of the letter will be forwarded to the 
Governmental Health Program Reimbursement Committee. This committee and the 
Council on Economics and Peer Review were authorized to inquire if carriers 
and state agencies are using Current Procedural Terminology III as the univer- 
sal reporting mechanism for physician services and to ask the AMA Council on 
Mental Health to encourage its use under federal programs. 

Mental Health Facilities 

After hearing complaints from several trustees that IDMH zone centers and other 
public mental health agencies are often closed when their services are needed— 
and that mental patients are being placed inappropriately in nursing homes be- 
cause other long-term care facilities are not available-the Board directed the 
Council on Mental Health and Addiction to study these problems and recommend 
possible solutions after appropriate discussions with the Department of Mental 
Health. 

Publications 

Due to increased printing costs, the Board authorized the Illinoi s Medical 
J ournal to raise its rates for certain advertising and for reprinting Journal 
articles. 

Annual Washington Roundup 

ISMS sponsorship of a vacation trip to Acapulco following the anual Washington 
Roundup was approved by the Board. ISMS members and their wives will have the op- 
portunity of attending only the roundup, January 19-22, or the combined Washing- 
ton-Acapulco trip. 

Alcoholism and Drug Dependence 

The Board endorsed the principal and direction of current activities of the 
Department of Mental Health's Alcoholism Division regarding establishment of 
detoxification centers. ISMS will offer assistance in developing appropriate 
educational curricula as well as continuing review and comment. All county medi- 
cal societies will be informed of this activity and encouraged to contact the 
IDMH Regional Alcoholism Coordinator so as to guarantee adequate physician re- 
view of local programs. A tentative program outline for the Conference Workshop 
on Drug and Alcohol Dependencies to be co-sponsored by ISMS October 4-5, 1974, 
in Bloomington, was presented to the Board. < 


212 


Illinois Medical Journal 


ISMS Guide to 
Continuing Medical Education 

Compiled for Illinois physicians by the 
ILLINOIS COUNCIL ON CONTINUING MEDICAL EDUCATION 
360 No. Michigan Ave. • Chicago, IL 60601 • (312] 782-1654 



Items for this Calendar must he received 90 days prior to the event. Those received earlier may appear in up to three 
monthly issues. 

If your organization’s CME activities are not listed— please contact us. To avoid possible conflicts, you’re invited also 
to consult our file of future events. 

WARNING! Items for this Calendar come from many sources, often far in advance of the publication date. Some- 
times, cancellations or changes in date, place or time occur too late to be corrected before publication. You are urged 
to contact the sponsoring organization to confirm information given below. 


OCTOBER 

Anesthesiology 

COURSE III— EKG FOR ANESTHESIOLOGISTS 

For: Anesthesiologists. 1-week course, Oct. 28-Nov. 1, 
1974, Chicago. CME Credit: 35 hrs. (approx.) AMA 
Category 1. Fee: $200. Reg. Limit: 35. Sponsor, 
contact: Cook County Grad. Sch. of Med., 707 S. 
Wood St., Chicago, IL 60612. 

ACUPUNCTURE ANESTHESIA 

For: All physicians, allied health. Weekly seminar, 

Oct 29, 1974, Memorial Hospital of DuPage Co., 
Elmhurst, III. Speaker: H. Havdala, M.D., Mt. Sinai 
Hosp. CME Credit: 1 hr. AMA Category 1. Sponsor, 
contact: J. H. Huss, M.D., Dir. Med. Educ., Mem. 
Hosp. of DuPage Co., Avon Rd. & Schiller St., Elm- 
hurst, IL 60126; (312) 833-1400, ext. 556. 

Basic Science 

ALCOHOLISM 

For: All Physicians, Allied Health. Weekly seminar, 

Oct. 1, 1974 (NOTE: date changed from Sept. 24), 

Memorial Hosp. of DuPage Co., Elmhurst, III. 

Speaker: Herbert Neuhaus, M.D., Dept, of Public 

Health Hosp., Chicago. CME Credit: 1 hr. AMA 

Category 1. Sponsor, contact: J. H Huss, M.D., 
Dir. Med. Educ., Memorial Hosp. of DuPage Co., 
Avon Rd. & Schiller St., Elmhurst, IL 60126. 
PRESENT DAY USE OF MICROBIOLOGY 
For: All Physicians, Allied Health. Weekly seminar, 

Oct. 22, 1974, Memorial Hosp. of DuPage Co., 

Elmhurst, III. Speaker: Frank Dorrigan, M.S. CME 

Credit: 1 hr. AMA Category 1. Sponsor, contact: 

J. H. Huss, M.D., Dir. Med. Educ., Memorial Hosp. 
of DuPage Co., Avon Rd. & Schiller St., Elmhurst, 
IL 60126. 

Cancer 

TUMOR BOARD 

For: All Physicians. Bimonthly meetings, Oct. 1 
and 15, 1974, 8:30 AM. Westlake Community Hosp., 
Melrose Park, III. CME Credit: 1 hr. each, AMA 
Category 2. Sponsor, contact: Westlake Community 
Hosp., 1225 Superior St., Melrose Park, IL 60160. 
TUMORS OF URINARY TRACT 

For: All Physicians. Symposium, Oct. 16, 1974, 

Ruth Lake Country Club, Hinsdale, III. CME Credit: 
3 hrs AMA Category 1. Reg. Deadline: Oct. 14, 
1974. Sponsor, contact: DuPage County Medical Soc., 
646 Roosevelt Rd., Glen Ellyn, IL 60137. 

Cardiovascular 

ECHOCARDIOGRAPHY WORKSHOP 

For: Specialists. 4-day workshop, Sept. 30-0ct. 3. 
1974, Indianapolis. CME Credit: 24'/2 hrs. AMA 
Category 1, AAFP. Fee: $125. Reg. Limit: 50. 
Sponsor, contact: Postgrad. Med Educ., Indiana Univ. 
Sch. of Med., Fesler Hall, 1100 W. Michigan, Indian- 
apolis, 46202. Co-sponsor: Amer. Coll Cardiology. 
CARDIAC CLINIC 

For: All Physicians. Monthly meeting, Oct. 8, 1974, 
8:30 AM, Westlake Community Hosp., Melrose Park, 
III. CME Credit: 1 hr. AMA Category 2 Sponsor, 
contact: Westlake Community Hosp., 1225 Superior 
St., Melrose Park, IL 60160; (312) 681-3000. 


REHABILITATION FOR RECENT ACUTE 
MYOCARDIAL INFARCTION 

For: All physicians, nurses. Lecture, Oct. 25, 1974, 
Martha Washington Hosp., Chicago. CME Credit: 1 hr. 
AMA Category 1. Sponsor, contact: F. Lopez-Fernan- 
dez, M.D., Med. Dir., Martha Washington Hospital, 
4055 N. Western Ave., Chicago, IL 60618. 

BASIC ELECTROCARDIOGRAPHY 
For: Family Physicians. 1-week course, Oct. 28-Nov. 
1, 1974, Chicago. CME Credit: 35 hrs. (approx.) 
AMA Category 1. Fee: $200. Reg. Limit: 35. Sponsor, 
contact: Cook County Grad. Sch. of Med., 707 S. 
Wood St., Chicago, IL 60612. 


Drug Dependencies 

CONFERENCE ON DRUG & ALCOHOL DEPENDENCIES 

For: All physicians, allied health, school & community 
workers. Symposium & workshop, Oct. 5, 1974 (plus 
Oct. 4, for school personnel only). Student Union, 
Illinois State Univ., Normal, III. CME Credit: 6 hrs. 
AMA Category 2. Fee: $5 (plus lunch). Reg. Dead- 
line: Sept. 27, 1974. Sponsor, contact: Committee on 
Alcoholism & Drug Dep., III. State Med. Soc., 360 
N. Michigan Ave., Chicago 60601; (312) 782-1654. 
Co-sponsor: McLean County Med. Soc. 


Endocrine-Metabolism 

THYROID DISEASE 

For: Family Physicians, Internists, Pediatricians, Nu- 
clear Medicine. l*/ 2 -day lecture/round table, Oct. 11- 
12, 1974, Pfister Hotel. Milwaukee, Wis. CME Credit: 
10 hrs AAFP. Fee: $125. Reg. Limit: 100 Sponsor, 
contact: Medical Coll, of Wis., c/o A. T. Finnegan, 
Ofc. of Cont. Educ., 561 N. 15th St. , Milwaukee, 53233. 
SODIUM & WATER METABOLISM 
For: All physicians, allied health. Weekly seminar, 
Oct. 15, 1974, Memorial Hospital of DuPage Co., 
Elmhurst, III. Speaker: A. R Lavender, M.D., Hines 
V.A. Hospital. CME Credit: 1 hr. AMA Category 1. 
Sponsor, contact: J H. Huss, M.D., Dir. Med. Educ., 
Mem. Hosp. of DuPage Co., Avon Rd. & Schiller St., 
Elmhurst, IL 60126; (312) 833-1400, ext. 556. 


Family Medicine 

SHOCK 

For: Family Physicians. Lecture/symposium, Oct. 9, 
1974, 12:30 PM, Community Hosp., Geneva, III. 

Speakers: R. Lillihei, M.D., Univ. of Minn. & R. 
Gunnar, M.D., Loyola Univ. CME Credit: 3 hrs. AMA 
Category 1. Reserv. required for luncheon. Sponsor, 
contact: Community Hosp., 416 S. Second St., 

Geneva, IL 60134; (312) 232-0771, ext. 248. 
MEDICINE FOR TODAY (Fall & Spring Series) 

For: Practicing Physicians, House Staff. Lecture series 
emphasizing Orthopedics, Psychiatry, Endocrinology, 
Pulmonary Function. Usually weekly, Oct. -Dec., 1974; 
Feb. -Mar., 1975, at these locations: Belleville, 
Berwyn, Central ia , Champaign, Chicago (Near West, 
North, Southwest), Harvey, Hinsdale, Melrose Park, 
Park Ridge, Peoria, Rockford, Rock Island, Spring- 
field. CME Credit: 30 hrs. max., AMA Category 1, 
AAFP Prescribed. Fee: $90, AAFP Mbrs., $100 non- 
mbrs. Sponsor, contact: Illinois Academy of Family 
Physicians. 14 E. Jackson Blvd., Suite 1532, Chi- 
cago 60604. 


General Interest /CME Methods 

INTRODUCTION TO CME TECHNIQUE 

For: Hospital and other CME program planners. Two 
identical workshops held simultaneously, Oct. 4-6, 
1974, Marriott Inn, St. Louis and Oak Brook Hyatt 
House, Oak Brook, III. CME Credit: 14 hrs. AMA 
Category 1 (plus 4 hrs. extra on completion of post- 
workshop assignment). Fee: $125. Reg. Limit; Dead- 
line: 20 each; Sept. 20, 1974. Sponsor, contact: 
Illinois Council on Cont. Med. Educ., 360 N. Michi- 
gan Ave., Chicago, IL 60601. 

General Interest 

THE OTHER DOCTOR IN YOUR PRIVATE PRACTICE 

For: All Physicians & Allied Health. Weekly seminar, 
Oct. 8, 1974, 11:30 AM. Memorial Hospital of Du- 
Page Co., Elmhurst, III. CME Credit: 1 hr. AMA 
Category 1 Sponsor, contact: John H. Huss, M.D., 
DME, Memorial Hospital of DuPage Co., Avon Rd. & 
Schiller St., Elmhurst, IL 60126; (312) 833-1400. 

Infectious Disease 

COURSE IN MODERN CARE OF INFECTIOUS DISEASE 

For: All Physicians. Bi-weekly course, 8:00 AM Oct. 
5, "Community Acquired Infection;" Oct. 16, "Life 
Threatening Infections;" Nov. 6, "Danger & Complica- 
tions of Antibiotics;" Nov. 20, "Infections in the 
Compromised Host;" Dec. 4, "Diarrheas, Gram Nega- 
tive, Septicemia, & Shock;" Westlake Community 
Hosp., Melrose Park, III Speaker: S. Levin, M.D., 
Rush Medical Center. CME Credit: 1 hr. each, AMA 
Category 2. Sponsor, contact: Westlake Community 
Hosp., 1225 Superior St., Melrose Park, IL 60160. 

Internal Medicine 

INDIANA REGIONAL MEETING 

For: Internists. Scientific meeting, Oct. 7, 1974, 
Indianapolis Convention Cntr., Indianapolis. Sponsor: 
Amer. Coll, of Phys. Contact: D. E Wood, M.D., 
6467 Holiday Drive E., Indianapolis, IN 46260. 

Neurology 

3RD ANNUAL CHILD NEUROLOGY SOCIETY MEETING 

For: Pediatric Neurologists. Annual meeting, Oct. 

10-12, 1974, Hilton Hotel. Madison, Wis. Sponsor, 
contact: Child Neurology Society, Box 486 Mayo, 

412 Southeast Union, Minneapolis, Minn. 55455. 

Nuclear Medicine 

ADVANCES IN DISEASE DETECTION BY 
NUCLEAR SCANNING 

For: All physicians. Frontiers of Medicine lecture, 
Oct. 9, 1974, Billings Hosp., Chicago. CME Credit: 
3 hrs. AMA Category 1, AAFP Fee: $20. Sponsor, 
contact: Frontiers of Med., Univ. of Chicago, Box 
451, 950 E. 59th St., Chicago 60637. 

Obstetrics-Gynecology 

POSTGRAD COURSE IN OB-GYN 

For: Ob/Gyn. Lecture, case presentation, discussion, 
Oct. 24-26, 1974, Cntr. for Cont. Educ., Univ. of 
Chicago, Chicago. CME Credit: 33 hrs. (approx.) AMA 
Category 1. Fee: $225. Sponsor, contact: F. P. Zus- 
pan, M.D., Chicago Lying-In Hosp., Univ. of Chicago, 
5841 S. Maryland Ave., Chicago, IL 60637. 

(Continued overleaf) 


for September, 1974 


213 


Otolaryngology 

OTOLARYNGOLOGY FOR THE FAMILY PRACTITIONER 

For: All Physicians. Workshop, Oct. 30, 1974, Indiana- 
polis. CME Credit: 6 hrs. AMA Category 1, AAFP. 
Fee: $35. Sponsor, contact: Postgrad. Med. Educ., 
Indiana Univ. Sch. of Med., Fesler Hall, 1100 W. 
Michigan, Indianapolis, IN 46202. 

Pediatrics 

MANAGEMENT OF PEDIATRIC HEART DISEASE 

For: All Physicians. 3-day course, Oct. 30-Nov. 1, 
1974, Chicago. CME Credit: 21 hrs. (approx.) AMA 
Category 1. Fee: $100. Reg. Limit: 45. Sponsor, 
contact: Cook County Grad. Sch. of Med., 707 S. 
Wood St., Chicago, IL 60612. 

Pharmacology 

PSYCHOPHARMACOLOGY 

For: All Physicians. Short course, Oct. 16, 1974, 
Gary, I nd. CME Credit: 6 hrs. AMA Category 1, 
AAFP. Fee: $35. Sponsor, contact: Postgrad. Med. 
Educ., Indiana Univ. Sch. of Med., Fesler Hall, 1100 
W. Michigan, Indianapolis, IN 46202. 

Psychiatry 

PSYCHOANALYTIC STUDY GROUP 

For: Psychiatrists. Lecture & discussion group series 
(9 sessions) beginning Oct. 5, 1974, 9-12 AM 
Northwestern Mem. Hosp., Wesley Pavilion, Chicago. 
Hrs. of InStr.: 3 each. Fee: $125/series. Reg. Limit, 
Deadline: 12; Sept. 27, 1974. Sponsor, contact: B. 
Blackman, M.D., CME Chm., Northwestern Univ., 670 
N. Michigan Ave., Chicago, IL 60611; (312) 337-3107. 
PSYCHIATRY FOR THE MEDICAL PRACTITIONER 
For: All Physicians. 4-day course, Oct. 7-10, 1974, 

Chicago. CME Credit: 24 hrs. (approx.) AMA Cate- 
gory 1. Fee: $175 Reg. Limit: 80. Sponsor, con- 

tact: Cook County Grad. Sch. of Med., 707 S. Wood 
St. , Chicago, IL 60612. 

CURRENT & FUTURE PERSPECTIVES IN DRUG ABUSE 

For: All Physicians. Lecture, Oct. 16, 1974, 7:30 

PM, Forest Hospital Professional Cntr., Des Plaines, 

III Speaker: P G. Bourne, M.D.. Special Action 
Ofc. for Drug Abuse Prevention, Washington, D.C. 
Fee: $15 ($5 students). Sponsor, contact: Forest 

Hospital, 555 Wilson Lane, Des Plaines, IL 60018. 
GENERAL PSYCHIATRY STUDY GROUP 
For: Psychiatrists. Lecture & discussion group series 
(9 sessions) beginning Oct. 19, 1974, 9-12 AM, 
Northwestern Mem. Hosp., Wesley Pavilion, Chicago. 
Hrs. of Instr.: 3 each. Fee: $125/series. Reg. Limit 
Deadline: 12; Sept. 27, 1974. Sponsor, contact: B 
Blackman, M.D., CME Chm., Northwestern Univ., 670 
N. Michigan Ave., Chicago, IL 60611; (312) 337-3107. 
PSYCHIATRY FOR THE ADOLESCENT 
For: All Physicians. Lecture, group discussion, Oct. 
23, 1974, 10 AM, Bethany Methodist Hosp.; Oct. 
23, 6 PM. Lincolnwood Hyatt House; Oct. 24, 10 AM, 
Belmont Hosp Speaker: Beverley Mead, M.D., Dept, 
of Psychiatry, Creighton Univ. Sch. of Med. CME 
Credit: 5 hrs. AMA Category 1. Fee: $10 (non- 
staff, for dinner). Reg. Deadline: Oct. 18, 1974. 
Sponsor: FA8 :1 -CME. Contact: Mr. D Larson, Bethany 
Methodist Hosp., 5025 N. Paulina, Chicago, IL 60640. 

Radiology 

DIAGNOSTIC RADIOLOGY 

For: Family Physicians. 1-week course, Oct. 7-11. 
1974, Chicago. CME Credit: 35 hrs. (approx.) AMA 
Category 1. Fee: $200 Reg. Limit: 25. Sponsor, 
contact: Cook County Grad. Sch. of Med., 707 S. 
Wood St., Chicago, IL 60612. 

Respiratory Disease 

CHRONIC BRONCHITIS & PULMONARY EMPHYSEMA 

For: All Physicians. Symposium, Oct. 29, 1974, 8:30 
AM, Westlake Community Hosp., Melrose Park, III. 
Speaker: H. Levine, M.D., Hines VA Hosp. CME 
Credit: l>/ 2 hrs. AMA Category 2. Sponsor, contact: 
Westlake Community Hosp., 1225 Superior St., Melrose 
Park, IL 60160. 

Surgery 

PRE & POSTOPERATIVE CARE OF PATIENTS 

For: Surgeons, Surgical Specialists. 4-day course, 
Oct. 29-Nov. 1, 1974, Chicago. CME Credit: 32 hrs. 
(approx.) AMA Category 1 Fee: $175. Reg. Limit: 80. 
Sponsor, contact: Cook County Grad. Sch. of Med., 
707 S. Wood St., Chicago, IL 60612. 

Urology 

SPECIALTY REVIEW— UROLOGY 

For: Specialists. SV^-day course, Oct. 2-5, 1974, 
Chicago. CME Credit: 30 hrs. (approx.) AMA Cate- 
gory 1. Fee: $150. Sponsor, contact: Cook County 
Grad. Sch. Med., 707 S. Wood St., Chicago 60612. 


NOVEMBER 


Alcoholism 

FIRST ANNUAL SYMPOSIUM ON ALCOHOLISM 

For: All physicians. Nov. 13, 1974, 9:00-11:00 AM, 
Robt. C. Hartmann, Sr., Auditorium, Martha Washing- 
ton Hosp., Chicago. CME Credit: 2 hrs. AMA Category 
1, AAFP Elective. Reg. Limit: 110. Sponsor, contact: 
F. Lopez-Fernandez, M.D., Med. Dir., Martha Wash- 
ington Hosp., 4055 N. Western Ave., Chicago, 60618. 


Basic Science 

SEX PROBLEMS IN MEDICAL PRACTICE 

For: All Physicians, Allied Health. Weekly seminar, 
Nov. 5, 1974, 11:30 AM, Memorial Hosp. of DuPage 
Co., Elmhurst, III. Speaker: D Renshaw, M.D , Loyola 
Univ. CME Credit: 1 hr. AMA Category 1. Sponsor, 
contact: J. H. Huss, M.D., Dir. Med. Educ., Me- 
morial Hosp. of DuPage Co., Avon Rd. & Schiller St., 
Elmhurst 60126. 

THE THORACIC OUTLET SYNDROME 

For: All Physicians, Allied Health. Weekly seminar, 
Nov. 26, 1974, 11:30 AM, Memorial Hosp. of Du- 
Page Co., Elmhurst, III. Speaker: J. Conn, Jr., M.D. 
CME Credit: 1 hr. AMA Category 1. Sponsor, contact: 
J. H. Huss, M.D., Dir. Med. Educ., Memorial Hosp. 
of DuPage Co., Avon & Schiller St., Elmhurst, 60126. 


Cardiovascular 

MANAGEMENT OF ACUTE MYOCARDIAL INFARCTION 

For: All Physicians. Symposium, Nov. 12, 1974, 8:30 
AM, Westlake Community Hosp., Melrose Park, III. 
Speaker: J Messer, M.D.. Presbyterian-St Luke's 
Hosp. CME Credit: 1 Vi hrs AMA Category 2. Sponsor, 
contact: Westlake Community Hosp , 1225 Superior 
St., Melrose Park, IL 60160; (312) 681-3000. 


Cancer 

TUMOR BOARD 

For: All Physicians. Bi-monthly meeting, Nov. 5 & 19. 
1974, 8:30 AM, Westlake Community Hosp., Melrose 
Park, III CME Credit: 1 hr. each, AMA Category 2. 
Sponsor, contact: Westlake Community Hosp , 1225 
Superior St., Melrose Park, IL 60160. 


Dermatology 

CUTANEOUS MEDICINE 

For: All physicians. Frontiers of Medicine lecture, Nov. 
13, 1974, Billings Hospital, Chicago. CME Credit: 3 
hrs. AMA Category 1, AAFP. Fee: $20. Sponsor, con- 
tact: Frontiers of Medicine, Univ. of Chicago, Box 
451, 950 E. 59th St., Chicago 60637. 


Family Medicine 

FAMILY PRACTICE REVIEW 

For: Family Physicians. Nov. 4-8, 1974, Chicago. 
CME Credit: 40 hrs. (approx.) AMA Category 1. Fee: 
$175. Reg. Limit: 50. Sponsor, contact: Cook County 
Grad. Sch. of Med., 707 S. Wood St., Chicago 60612. 


General Medicine 

WEBER MEDICAL CLINIC FALL SEMINAR 

For: Generalists. Seminar, Nov. 2, 1974, Olney Central 
College, Olney, III. CME Credit: 4 hrs. AMA Category 
2. Reg. Deadline: Oct. 25, 1974. Sponsor, contact: 
D. L. Potter, Admin., Weber Medical Clinic, 1200 N. 
East St., Olney, 62450. Co-Sponsor: SIU Sch. of Med. 

CARLE CLINICAL CONFERENCE & LECTURE 

For: All Physicians, Dentists. Clinical conference, Nov. 
13. 1974, Ramada Convention Cntr., Champaign, III. 
CME Credit: 4 hrs. AAFP. Sponsor, contact: Carle 
Foundation, 611 W. Park St., Urbana, IL 61801. 


Infectious Disease 

ADVANCES IN INFECTIOUS DISEASES 

For: All Physicians, Nurses. Lecture, Nov. 7 1974, 
11:00 AM, Martha Washington Hosp., Chicago. 
Speaker: M. Mufson, M.D., Univ. of III. CME Credit: 
1 hr. AMA Category 1, AAFP Prescribed. Sponsor, 
ccntact: F. Lopez-Fernandez, M.D., Med. Dir., Martha 
Washington Hosp., 4055 N. Western, Chicago, 60618. 


Internal Medicine 

BASIC INTERNAL MEDICINE 

For: All physicians. Nov. 11-15, 1974, Chicago. CME 
Credit: 40 hrs. (approx.) AMA Category 1. Fee: $175. 
Reg. Limit: 50. Sponsor, contact: Cook County Grad 
Sch. of Med.. 707 S. Wood St., Chicago 60612. 


VENEREAL DISEASES 

For: All Physicians. Short course, Nov. 13, 1974, 
Gary, Ind. CME Credit: 6 hrs. AMA Category 1, AAFP. 
Fee: $35. Sponsor, contact: Postgrad. Med. Educ., 
Indiana Univ. Sch of Med., 1100 W. Michigan, In- 
dianapolis, IN 46202. 

DISEASES OF LIVER & G.l. TRACT 

For: All Physicians. Group discussion & lecture, Nov. 

15, 1974, 10:00 AM, Belmont Community Hosp.; 
Nov. 15, 6:00 PM, Lincolnwood Hyatt House; Nov. 

16, 10:00 AM, American Hosp. of Chgo., Chicago. 
Speaker: S. E. Goldfinger, M.D., Harvard Med. Sch. 
CME Credit: 5 hrs. AMA Category 1, AAFP. Fee: $10 
(non-staff, for dinner). Reg. Deadline: Nov. 11, 1974. 
Sponsor: FAB3/CME. Contact: Mr. J. McCracken, Bel- 
mont Community Hosp., 4058 W. Melrose St., Chi- 
cago, IL 60641; (312) 736-7000. 

ELECTROLYTE IMBALANCE IN CLINICAL PRACTICE 
For: All Physicians, Nurses. Lecture, Nov. 21, 1974, 
11:00 AM, Martha Washington Hosp., Chicago. 
Speaker: N. Kurtzman, M.D., Univ. of Illinois. CME 
Credit: 1 hr. AMA Category 1, AAFP Prescribed. 
Sponsor, contact: F. Lopez-Fernandez, M.D., Med. 
Dir., Martha Washington Hosp., 4055 N. Western Ave., 
Chicago, IL 60618; (312) 583-9000, ext. 331. 

Laryngology 

LARYNGOLOGY & BRONCHOESOPHAGOLOGY 

For: All physicians. Symposium, Nov. 18-23, 1974, 
Chicago. Hrs. of Instr.: 42. Fee: $300. Reg. Limit, 
Deadline: 20; Nov. 17, 1974. Sponsor, contact: Univ. 
of III Abraham Lincoln Sch. of Med., 1855 W. 
Taylor St. , Chicago, IL 60612. 

Neurology 

NEUROPHYSIOLOGICAL & CLINICAL 
ASPECTS OF ACUPUNCTURE 

For: Physicians, Surgeons, Dentists. 3-day conference, 
Nov. 7-9, 1974, Hilton Hotel, Madison, Wis. CME 
Credit: AAFP Prescribed, AMA Category 1. Fee: $90 
(before Sept. 1); $110 (after Sept. 1). Sponsor, con- 
tact: Dept of Cont. Med. Educ., Univ. of Wis., 610 
N. Walnut St., Madison, Wl 53706. 

Obstetrics-Gynecology 

FEMALE CLIMACTERIC 

For: All physicians, allied health. Weekly seminar, 

Nov. 19, 1974, Memorial Hospital of DuPage Co., 
Elmhurst, III. Speaker: A Scommegna, M.D., Michael 
Reese Hosp. CME Credit: 1 hr. AMA Category 1. Spon- 
sor, contact: J. H Huss, M.D., Dir. Med. Educ., 
Mem. Hosp. of DuPage Co., Avon Rd. & Schiller St., 
Elmhurst, IL 60126; (312) 833-1400, ext. 556. 
PRACTICAL OBSTETRICS & GYNECOLOGY 
For: Specialists & Family Physicians. Short course, 
Nov. 20, 1974, Airport Holiday Inn, Indianapolis. 
CME Credit: 6 hrs. AMA Category 1, AAFP. Fee: $35. 
Sponsor, contact: Postgrad Med. Educ., Indiana 

Univ. Sch. of Med., 1100 W. Michigan, Indianapolis, 
IN 46202. Co-Sponsor: Indiana Acad. Family Phys. 

Orthopaedics 

OFFICE ORTHOPAEDICS 

For: All Physicians. Short course, Nov. 6, 1974, 

Indianapolis. CME Credit: 6 hrs. AMA Category 1, 
AAFP. Fee: $35. Sponsor, contact: Postgrad. Med. 
Educ., Indiana Univ. Sch. of Med., 1100 W. Michigan, 
Indianapolis, IN 46202. 

Psychiatry 

ON DEATH & THE CONTINUITY OF LIFE 

For: All physicians. Lecture, discussion, Nov. 20, 

1974, 7:30 PM, Forest Hosp Professional Cntr., Des 
Plaines, III. Speaker: R. Litton, M.D., Yale Univ. 
Fee: $15 ($5 students). Sponsor, contact: Forest 

Hosp., 555 Wilson Lane, Des Plaines, IL 60016. 

Respiratory Disease 

RESPIRATORY CARE CONFERENCE 

For: All Physicians. Monthly meeting, Nov. 26, 1974, 
8:30 AM, Westlake Community Hosp., Melrose Park, 
III CME Credit: 1 hr. AMA Category 2. Sponsor, 
contact: Westlake Community Hosp , 1225 Superior 
St., Melrose Park, IL 60160; (312) 681-3000. 

Surgery 

SPECIALTY REVIEW, PART I 

For: Specialists. Nov. 4-15, 1974, Chicago. CME 

Credit: 94 hrs. (approx.) AMA Category 1. Fee: $350. 
Reg. Limit: 150 Sponsor, contact: Cook County Grad. 
Sch. of Med., 707 S. Wood St., Chicago 60612. 

BLOOD VESSEL SURGERY 

For: Specialists. Nov. 18-22, 1974, Chicago. CME 

Credit: 40 hrs. (approx.) AMA Category 1. Fee: $300. 
Reg. Limit: 40 Sponsor, contact: Cook County Grad. 
Sch. of Med., 707 S. Wood St., Chicago 60612. 


14 


Illinois Medical Journal 


History of Medicine 


Edmund Andrews: The Forgotten Pioneer of 

Chicago Urology 

By Joseph H. Kiefer, M.D. /Chicago 


Dr. William T. Belfield has, by universal ac- 
claim, been accorded the honored title of “The 
Father of Urology in Chicago.” A man with a 
national reputation as a bacteriologist and an 
eminent surgeon, he began about 1885 to restrict 
his practice to urology. He was a member of the 
founding group and the first president of the 
Chicago Urological Society at its inception in 
1903 and he retained his pre-eminent position 
until his death in 1929. 

If Dr. Belfield was the Father of Chicago 
Urology, there is another man who rightly de- 
serves the title of Grandfather. His name is not 
mentioned in any of the histories of urology in 
Chicago and his role in the development of this 
specialty has not been brought out. 1 - 2 ’ 3 ' 4 

Possibly the reason for this omission is the 
fact that the first historian, Dr. Kretschmer, 
in his history of the earliest period, mentioned 
only the men who were connected with the 
Rush Medical College. Later historians have 
apparently taken their cues from him. The 
period we are talking about is that from 1850 
to about 1885. 

I found out about Dr. Andrews and his nrologic 
interest only by chance. 1 have long collected 
books on the history of urology and some years 
ago I saw catalogued an item, by one J. Griin- 
feld, M.D., entitled “Geschichte cler Endoskopie,” 
dated 1879. 6 I purchased this small book and, 
on looking through it, I was surprised to see 
among those who had helped develop the endo- 
scope, the name of a Dr. E. Andrews of Chicago. 
I looked up the reference, obtained photocopies 
from the John Crerar Library, and realized that 
Dr. Andrews had apparently not only shown 
a very definite interest in urologic instrnmenta- 

JOSEPH H. KIEFER, M.D., Chicago, 
is Professor of Urology, University of 
Illinois, Abraham Lincoln School of 
Medicine; Senior Consultant, University 
of Illinois Hospitals; and attending 
urologist at St. Joseph's and Augustana 
Hospitals. He received his medical de- 
gree from Northwestern University and 
is a member of Chicago and American 
Societies for Medical History. 



Figure 1. Edmund Andrews (1824-1894). 


tion in the pre-cystoscopic days but, also, had 
reported many cases of instrumental treatment 
of bladder stone. As far as 1 can estimate, after 
reviewing journals of the period, he reported 
more cases of this type than all of the rest of 
the surgeons in Chicago put together. That he 
was acknowledged at the time to be an expert 
in the urologic field is evident by the fact that, 
in 1874, he was selected by the Illinois State 
Medical Society to be chairman of a special 
committee on urethral strictures. He published 
over 30 items on urological subjects up to the 
year 1898, all before the Chicago Urological 
Society was formed. Despite this, there was no 
mention of his name in a history of Urology in 
Chicago until my own “History of Urology in 
Illinois,” published in the Illinois Medical 
Journal February, 1970. 12 

The Life of the Urologist 

Edmund Andrews was born in Putney, Ver- 
mont in 1824. His father, the Reverend Elisha 
Andrews, was a Congregationalist minister. When 
Edmund was 17 years old, the family moved to 
Armada, Michigan and in 1846, Edmund went 
to the University of Michigan which had just 
opened. He received a Bachelor’s Degree in 



for September, 1914 


215 


1849 and began a preceptorship with a Dr. Zina 
Pitcher. The next year he entered the Univer- 
sity of Michigan Medical School which also had 
just opened, teaching to pay his way. He re- 
ceived a Medical Degree there in 1852 and also 
a Master’s Degree in Arts. Years later, in 1880, 
he was awarded an honorary LL.D. Degree by his 
alma mater. 

In April 1853, he married Miss Sarah Eliza 
Taylor of Detroit. They had three sons, Dr. E. 
Wyllys Andrews, a surgeon, Dr. Frank Taylor 
Andrews, a gynecologist, and Edmund Lathrop 
Andrews, an electrical engineer. Dr. E. Wyllys 
had a son, Edmund, who became a surgeon and 
died in 1941. 

Immediately after graduation, he became a 
Demonstrator in the Anatomy Department and 
at once became active in the medical world. 
He helped organize the Michigan State Medical 
Society and was Editor of the Peninsular Journal 
of Medicine and Collateral Sciences. In 1855, he 
was invited to Chicago to become Demonstrator 
in Anatomy at Rush Medical College. In 1859, 
he joined the group of insurgents of the Rush 
faculty who wished to inaugurate a graded 
curriculum. 

At that time, the medical course consisted 
of a series of lectures extending over about 14 
weeks. All students attended these lectures and 
came back the next year and repeated the same 
course over. At the end of the second series, they 
were graduated. The group of Rush professors, 
under the leadership of Nathan Smith Davis, 
who wished to set up a graded course of study 
were voted down by Daniel Brainerd and the 
majority of the Rush faculty. They, therefore, 
resigned and organized a new medical school 
attached to Lind University and Dr. Andrews be- 
came Professor of Surgery. Within a couple of 
years, Lind University dissolved, to be reorganized 
later as Lake Forest College. The medical school 
continued independently and was renamed the 
Chicago Medical School. In 1869, it affiliated 
with Northwestern University and became its 
medcial school. 

About 1856, when Mercy Hospital was orga- 
nized, Dr. Andrews was named Chief Surgeon 
and remained so for almost 50 years. From the 
very beginning, his intention was to practice 
surgery only and he did no general practice. 

In those days, urologic surgery consisted chiefly 
of operations for bladder stone, either open 
lithotomy or instrumental by lithopaxy or litho- 
trity. There was a small amount of surgery on 
the external genitalia, such as operations for 
hydrocele, for varicocele and also orchidectomy 


for tumor. Included also was treatment for ure- 
thral infections and their sequelae, the chief of 
which was urethral stricture. Urinary obstruction 
was treated by catheterization or trocar puncture 
of the bladder. These procedures were carried 
out by surgeons who also did every other kind 
of surgical procedure. 

A review of medical journals of that time in 
Chicago, as well as of the Transactions of the 
Illinois State Medical Society, reveals that Dr. 
Andrews published more reports of urologic 
surgery than any other man. His case books 11 
show that he recorded his first lithotomy in 1855 
(Figure 2) . He soon developed a special interest 
in urinary tract instrumentation. 

Desormeaux of Paris had begun his attempts 
to design an endoscope about 1853. In 1865, he 
published a book “De l’Endoscope,” 5 describing 
the first workable instrument to visualize the 
urethra and the bladder as well as other organs. 
Phe endoscope, while very inefficient by present 
standards, at least enabled the skilled operator 
to get a view, poor as it was, of the inside of the 
bladder. In 1867, a long article by Desormeaux 
was printed in the Chicago Medical Journal in 
six sections, but no Chicago surgeon, other than 
Dr. Andrews, seemed to evidence any interest 
in it. 

An article by Dr. Andrews appeared in the 
Chicago Medical Examiner of 1868, describing 
an improvement on Desormeaux’s endoscope by 
which a magnesium wire was fed into the flame 
of the oil lamp from which the light was derived 
(Figure 3) . This was an attempt to overcome 
the poor lighting which was its major defect and 
which was only overcome when Nitze, more than 
ten years later, put the light source at the internal 
end of the tube. Barber, in his History of Urology 
in Chicago, 3 reported that, in 1882, Rufus 
Bishop first brought an endoscope to Chicago, 
but he was obviously unaware of Andrews’ much 
earlier work. This attempt of Andrews was duly 
reported by Griinfeld in his “History of Endo- 
scopy,” where I first saw the name of Andrews 
mentioned. 

In 1871, Andrews made another attempt to 
improve the light using a row of gas jets 10 
inches long as a light source; apparently with 
no more success. 

In 1874, as mentioned above, a special com- 
mittee of the Illinois State Medical Society was 
appointed to make a study of urethral strictures 
and Andrews was named its Chairman. In 1877, 
he published a study of the mortality of lithot- 
omy in the Lake States as compared to that in 
Europe, and found it to be definitely higher. 


216 


lllmois Medical Journal 


Figure 4 



By Edmund Andrews, M. D., LL. D., Chicago.* 


One Hundred Operations for Urinary Calculi. 

The object of this paper is to compare the safety of 
litholapaxy with that of lithotrity and of lithotomy, so far 
as my own practice is concerned. 

The following is a summary of my results: 

Cases, Deaths. Per cent, of 


Litholapaxy (Bigelow's operation.) 

40 

mortality. 

1 24 

Lithotrity( after Sir Henry Thomp- 
son’s method.) 

6 

Lithotomy (at all ages and by all 
methods.) 

55 


Lithotomy (below age of puberty) 

26 

2 8 

Lithotomy (above age of puberty) 

29 

5 1 7 


As all the litholapaxies were done upon adults, the one 
single death in forty cases contrasts strongly with the five- 
deaths in twenty-nine adult lithotomies. 


Figure 5 


Figure 2. Record of Dr. Andrew 
first bladder stone case — 1855 or 
before. Autograph Case Record 
Books — Northwestern U. Med. Scbl 
Library. 

Figure 3. Apparatus for improving 
the light for the Endoscope by 
feeding magnesium wire into the 
flame of the oil lamp. Chi. Med. 
Examiner 9: 471 1868. 

Figure 4. Auscultation Sound. Chi. 
Med. J. and Examiner 36: 597 
1878. 

Figure 5. Summary of One Hun- 
dred Operations for Urinary Cal- 
culi, Trans. 111. St. Med. Soc. 39: 
173-4 1889. 




n*t 



PU4 


Figure 3 


In 1878, in the Chicago Medical Journal and 
Examiner, he described a sound which he had 
invented to detect small stone fragments re- 
maining in the bladder after lithopaxy. He 
called it an “auscultation sound.” (Figure 4) It 
consisted of a metallic sound, hollow, with a 
rubber tube connecting the end to an earpiece. 
This would greatly magnify any sound created 
by contact with tiny stone fragments in the 
bladder. This was most important in determining 
completeness of removal of all fragments in the 
pre-cystoscopic days. 

In 1882, he published an article on “Rapid 
Lithotrity” in the Chicago Medical Review; and, 
in 1884, another in the Journal of the AM A 
(JAMA) entitled “Rapid Lithotrity or Litho- 
lapaxy.” This last term was the name given by 
Bigelow of Boston to the procedure by which 
crushing of bladder stone and evacuation of the 
pieces were carried out at a single setting. In 
1889, in JAMA, Andrews published a report on 
the comparative results of lithotomy, litholapaxy, 
and lithotrity in 100 operations for stone with 
a table of results. (Figure 5) These were all his 
own cases and this report gives an indication of 
the great interest which he had in urologic 
surgery. 

He kept detailed case and record books in his 
own hand; these and other memorabilia are in 


the Northwestern University Medical School 
Library. 11 (Figure 2) 

That Dr. Andrews was generally acknowledged 
to be the leader in the field of urological surgery 
is forcefully brought forth in the reports of 
two meetings of the Chicago Medical Society in 
1886. At the February meeting of the Society, 
Dr. Belfield reported seven cases of digital ex- 
ploration of the bladder through a suprapubic 
incision. This was the only method by which 
exact information about lesions in the bladder 
could be obtained if sounding for stone did not 
give a positive answer. It was while doing one 
of these explorations that Dr. Belfield found a 
protruding intravesical prostatic lobe and re- 
moved it, establishing his priority as the first 
suprapubic prostatectomist. My main purpose 
in mentioning this report, however, is to note 
that the man selected to open the discussion 
of Dr. Belfield’s paper was Dr. Edmund Andrews. 
Obviously, those of his time thought him best 
qualified to discuss this urologic procedure. The 
compliment was returned three months later 
when, at the May meeting of the Society, Dr. 
Andrews reported on a new evacuator for litho- 
paxy and the man chosen to open the discussion 
on this paper was none other than Dr. Belfield. 
The line of descent from the Grandfather to the 
Father of Chicago Urology is here apparent. 


for September, 1974 


217 


This was truly a transition point. Dr. Andrews 
was, at this time, 62 years old. Dr. Belfield was 
only 30 and at the very start of his career. 
Dr. Belfield was already evidencing the special 
interest in urology which led him to restrict 
his work to this field and later to found the 
Chicago Urological Society. 

Dr. Edmund Andrews lived to be almost 
80 years old, dying on the January 22, 1904, 
just three months short of that mark. The only 
account I find of his last illness states that a 
bladder calculus was diagnosed and removed. 
A contemporary news account 9 states that Dr. 
Andrews was operated upon by his two sons, 
Drs. E. Wyllys and Frank, but I have been un- 
able to learn the nature of the operation. 
He was said to be doing well and ambulated 
when, on the sixth day postoperative, he had a 
sudden episode of respiratory embarrassment. 
Oxygen was administered, but he died within 
an hour. The story woidd be compatible with a 
coronary attack. Likewise, the death certificate, 10 
which gives “acute dilatation of the heart” and 
“atheromatous vessels with myocarditis,” evi- 
dently found at autopsy. It is rather tragic that 
his death was the result of a complication of 
bladder stone, the disease about which he had 
thought and written so much and for which he 
was so expert an operator. 

Memorial services were held at the Second 
Presbyterian Church, where he had been a life- 
time member, and were attended by all the 
medical leaders of the day. Dr. John B. Murphy 
presided. 

Besides urology. Dr. Andrews evidenced spe- 
cial interest in several other fields of surgical 
practice. One of the most important and one 
in which he was also a true pioneer was the 
field of anesthesia. As early as 1868, he reported 
the use of a mixture of oxygen with nitrous 
oxide to prevent the asphysia which was so 
dangerous with the use of nitrous oxide alone 
and which, till that time, restricted its use to 
such operations as dental operations which re- 
quired only a very short period of anesthesia. 
There are two major biographical sketches of 
Dr. Andrews, one by Dr. Arno Luckhardt 7 and 
the other by Drs. Manuel Lichtenstein and 
Method, 8 which emphasize his important work 
in anesthesia, but say little of his urological 
activities. 

He had visited Lister in 1867 and Ludvig 
Hektoen said he was the first surgeon in Chicago 
to commend “antiseptic surgery.” He urged the 
use of carbolized water for litholapaxy. 


Figure 6. Urologic Bibliography of E. Andrews 

1855 Personal Case Book — Report of his first 
lateral lithotomy. 

1867 Trans 111 St. Med. Soe, V5:113. Magnesium 
wire for endoscopic light. 

1868 Chi. Med. Examiner V 9. p. 468. Magnesi- 
um wire for endoscopic light. 

1871 Trans 111 St. Med. Soc, V 21. Row gas jets 
10” long for endoscopic light. 

1874 Trans 111 St. Med. Soc, V 24. Edmund An- 
drews, Chairman of Special Committee on 
Urethral Stricture. 

1878 Chi. Med. J. & Examiner V 36:592. Lithot- 
rity, Auscultation Sound. 

1881 Chi. Med. J . & Examiner V 43:71. Clinic 
on Lithotrity. 

1882 Chi. Med. Rev, V 6:571. Rapid Lithotrity. 

1884 JAMA , V 2:281. Rapid Lithotrity or Lithol- 
apaxy. 

JAMA, V 3:485. Carbolized Water in Lithol- 
apaxy — 19 cases. 

Chi. Med. J. & Examiner V 49:487. Lithol- 
apaxy, Varicocele. 

1885 Chi. Med. J. & Examiner V 51:68. Two 
Cases Lithopaxy. 

1886 JAMA. V 6:626. Rapid Evacuator for 
Litholapaxy — continuous flow. 

JAMA, V 6:626. New Method of Attach- 
ing Filiform Guides to Stricture Instru- 
ments. 

Chi. Med. J. & Examiner V 52:363. Dis- 
cussion of Paper by W. T. Belfield, “Seven 
cases of digital exploration of the bladder.” 
Chi. Med. J. & Examiner V 53:610. New 
Evacuator for Litbopaxy. 

1889 Chi. Med. J. & Examiner V 58:262. Two 
Cases in Which Litholapaxy was Impos- 
sible. 

JAMA, V 12:829. Comparative Results of 
Lithotomy, Litholapaxy, and Lithotrity in 
100 Operations for Stone. 

Trans 111 St Med. Soc, V 39:173. One 
Hundred Operations for Urinary Calculus. 
Also printed in the New Orleans M & S J. 

1890 Trans 111 St Med Soc, V 40:134. Report on 
Prostatic Surgery (with Chenoweth). 

1893 Chi. Med. Rec, V 4:171. Management of 
Recurrent Urinary Calculi Without Cut- 
ting or Crushing. 

Internatl Clinics, V 1:261. Recurring Cal- 
culi from the Kidney and Cure Without 
Nephrectomy or Litholapaxy. 

Chi. Clin. Rev, V 2:143. The Great Ab- 
scesses Situated Behind the Adbonimal 
Cavity. 

1895 Chi. Med. Rec, V 8:1. Irritable Testis — A 
Study of a Few Suggestive Cases. 

Internatl Clinics, V 1:203. Castration for 
Enlarged Prostate. 

Chi. Med. Rec, V 8:175. Castration in 
Desperate Cases of Senile Cystitis. 

1896 No. Am. Practitioner, V 8:203. Division of 
the Vas Deferens for Senile Hypertrophy 
of the Prostate and Cystitis. 

1898 JAMA, V 30:173. The Oriental Eunuchs. 

Internatl Clinics, V 3:220. Comparative 
Results of the Four New Operations for 
Hypertrophy of the Prostate Gland. 


218 


Illinois Medical Journal 


He also wrote many articles on orthopedic 
conditions, and in his later life, wrote a number 
of articles on rectal and anal surgery, mostly 
in collaboration with his son, E. Wyllys Andrews. 

He served in the Union Army dming the 
Civil War with the armies of Grant at Vicksburg 
and with Sherman, and wrote medical histories 
of these campaigns. He insisted on systematic 
records, which was an innovation at that time. 

He wrote about 14 articles which related to 
medical history, including the Civil War histories 
just mentioned. He reviewed the medical history 
of President Cleveland and the surgical treat- 
ment given him at the time of his assassination; 
and also that of Napoleon III, his illness and 
death, which followed operations by Sir Henry 
Thompson for bladder stone. 

He showed an unusually inquiring mind and 
a definite mechanical tendency in his attempts 
to improve urologic instrumentation, both the 
endoscope and instruments for transurethral 
stone crushing and removal. He encouraged the 
use of litholapaxy, proclaiming its greater safety 
over open surgeny. He must have been a very 
adept man with transurethral instruments. 

Dr. Andrews was elected to the Presidency of 
both the Chicago Medical Society and the Illinois 
State Medical Society. 

He was said to be a plain, but forceful speaker, 
without oratorical flourishes. His writings were 
clear, brief, and in simple language. While not 
given to levity in his classes or speech, he was 
said to have a good sense of humor and to be 
a very friendly person. He was kindly and 
sympathetic to his patients, of whatever status, 
rich or poor. It is recounted that the only time 
lie was heard to rebuke a patient was when the 
patient made a disparaging remark about his 
former physician. A doctor who knew him well 
said that he never heard him say an unkind word 
about any other doctor, certainly not a general 
trait in those days. 

He was said to be able to read Latin, Greek, 
and Hebrew and even occasionally to compose 
poetry in Latin or Greek. He was a member 
of the Chicago Literary Club and had a large 
library. 

Coming as he did, from a religious family, 
it does not surprise us to find that he was said 
to be a very religious man but without any 
ostentation. As one friend said, “He merely 
lived his religion and never made any show 
of it.” Social activity had no appeal for him. 


He was an artist of considerable talent. He 
illustrated his own articles and painted a series 
of bird pictures as well as scenes around Mem- 
phis and Vicksburg during his military service. 
He even designed an organ for his church. 

Among his non-medical interests, the chief 
subject was natural science, especially geology 
and archaeology. He wrote several lengthy ar- 
ticles on the geology of the Great Lakes region. 

He was a founder, in 1857, of the Chicago 
Academy of Science and was its president for a 
number of years. It was said of him that he 
could have filled a Chair in Geology, in Litera- 
ture, or in Theology, as well as in Surgery. 

Certainly, Dr. Edmund Andrews stands out 
as the pre-eminent urologic surgeon of the period 
from 1855 to 1885, until the appearance of men 
like Drs. Belfield and G. Frank Lvdston, and 
later Drs. Gustav Kolischer and Louis Schmidt, 
who restricted their entire practice to urology. 

It is amazing that a man who did so much in 
the urologic field and wrote so copiously about 
it and who was recognized by his contemporaries 
for his urologic ability was lost to memory. I 
think that he should be reinstated to his rightful 
place in the History of Urology in Chicago as 
an eminent pioneer in urologic surgery, even 
though he antedated the formation of urology 
as a separate specialty. 

References 

1. Kretschmer, Herman L.: Early history of Urology in 
Chicago, A History of Urology. Am. Urol. Ass?i. 
1933. 

2. Baker, William I.: History, Progress and Present 
Status of Cystoscopy at Cook County Hospital, Proc. 
Inst. Med. Chicago 22:32, Mar. 15, 1958. 

3. Barber Knowlton E.: History of Urology in Chicago, 
Chicago Medicine 63:40-43: 36-39: 32-35. 

4. O’Conor, Vincent J.: The History of Urology in Chi- 
cago, J. Int. Coll. Surg. 39:396, 1963. 

5. Desormeaux, A. J.: De L’Endoscope 1865 Paris, The 
Endoscope (trans. R. P. Hunt) Chicago Med J. 24: 
1867. 

6. Griinfeld, Josef: Zur Geschichte der Endoskopie, 

Wien 1879. 

7. Luckhardt, Arno B.: Anesth. and Analg. 19:2, 1940. 

8. Lichtenstein, Manuel E. and Method, Harold: “An- 
drews, Edmund A Biographical Sketch, etc.” Quart. 
Bull. Northwestern Univ. Med. Schl. 27:336, 1953. 

9. Chicago Tribune, Jan. 23, 1904. 

10. Chicago Board of Health— Death certif. 5946—1904. 

11. Autograph Case Record and Account Books, North- 
western U. Med. Schl. Library. 

12. Kiefer, Joseph H., History of Urology in Illinois, III. 
Med. J. 157:54 Jan. 1970. 


for September, 1974 


219 



of the doctor’s wife 


Mrs. Harold Keegan, Editor 


J 


Back to School 


As the summer draws to a close we leave behind summer vacations, swimming, 
camps, fairs and “no” auxiliary meetings. 

In September everything starts to roll again. The kids are back in school, 
auxiliary meetings once again begin and also district meetings. This year the 
district meetings have been divided into smaller groups and more centrally lo- 
cated. All the programs will follow a main theme of Legislation and Communica- 
tions. Each meeting will have a guest speaker at the luncheon. The morning 
program will include a sharing of County President’s programs, projects and 
problems, a “Swap Shop” (an idea exchange) and election of district councilors 
in all the even districts. The District Councilors and County Presidents are work- 
ing hard to interest many members in attending the meetings. 

Legislation has become so important to the doctor it is now time that the 
doctor’s wife assume her role in working for good medical legislation. The 
district meetings should help inform us about future medical legislation. Also it 
is a good way to exchange ideas. 

Look for the second quarterly issue of the Pulse in September. 



DISTRICT 

MEETINGS 

September 10 

District 4 

Rock Island Country Club 

September 17 

District 5-6 

Pekin Country Club 

September 19 

District 1-2 

Elgin Holiday Inn 

September 27 

District 11 

White Fence Farms, Joliet 

October 10 

District 7-8 

Danville 

November 7 

District 9-10 

Exposition Hall, Belleville 

February 11 

District 3 

Chicago 


220 


Illinois Medical Journal 


Scenes From National Convention 



Left: Presidents from Illinois gathered 
during the WA/AMA Convention held 
last June in Chicago; from left to 
right: Mrs. Harlan English, W A /AM A 
Past President; Mrs. Willard C. Scriv- 
ner, WA/AMA Immediate Past Presi- 
dent; Mrs. Robert Hartman, W A /ISMS 
Immediate Past President; Mrs. Thomas 
Clatter, W A/ ISMS President; and Mrs. 
Eugene Vickery, W A /ISMS President- 
Elect. Right: During the installation 
reception Mrs. Eugene Vickery chatted 
with the newly installed WA/AMA 
Presidetit from Hawaii, Mrs. Howard 
Liljestrand. Below: Mrs. Willard C. 
Scrivner is welcomed back home ivith 
a gift from the Illinois auxiliary. Pre- 
senting the gift is Mrs. Thomas Glatter. 





pie 5 



Mrs. Leo V. Kempton, 
a member of the Du- 
Page County Auxilia- 
ry for 1 2 years, is serv- 
ing this year on the 
State Board as Rec- 
ording Secretary. Alice 
has been a very busy 
gal. On the County 
level she has served as 
President, Vice-presi- 
dent, Director, Recording Secretary, AMA-ERF 
Chairman, Health Careers Chairman and Year- 
book Chairman. On the State level Alice has 
served as Hospitality Chairman, Aging and 
Homebound Chairman and filling a vacancy 


last year as Recording Secretary. 

Alice, originally from Wisconsin, and her 
husband, a psychiatrist in private practice in 
Elmhurst, live in Itasca, where she is active 
with the local FISH group and the Rush Faculty 
wives. 


Mrs. L. P. Johnson, 
our Corresponding 
Secretary, is a charter 
member of Winne- 
bago County Auxilia- 
ry and has served on 
the County Board in 
various capacities for 
14 years. This is her 
first year on the State 
Board. 

Cathy and her husband, a general practitioner 
and Assistant Dean of the Rockford Medical 
School, have three children. Even though she 
is a new grandmother, she still has time to do 
volunteer work for Swedish-American Hospital 
and the Rockford Museum. 



for September, 1974 


221 


Replacing the Doctor Draft 

( Continued from page 196) 

By means of these three programs, the civilian 
student scholarship plan, the incentive pay for 
career officers, and the establishment of a nation- 
al medical school, the Department of Defense 
is hopeful that its needs for physicians can be 
met without the use of the Selective Service Sys- 
tem. It is impossible to predict whether this plan 
will be successful, but there are no plans in the 
immediate future for re instituting the “doctor 
draft.” 

References 

1. Fact Sheet, Subject: Special Pay for Medical Officers 
of the Uniformed Services (Medical Officers Variable 
Incentive Pay) , D. of D., undated. 

2. Public Law 92-426, 92nd Congress H.R. 2, September 
21. 1972, Chapter 105, Sections 2120-2127. 

3. Public Law 92-426, 92nd Congress H.R. 2, September 
21, 1972, Chapter 104, Sections 2112-2117. 

4. Private Communication, May 17, 1974. 


EKG of the Month 

Continued from (page 191) 

Answers: 1. A,B,C 2. A ,B,D,E 
The ECG shows large O waves in leads VI to V4 
in the precordial leads with a ORS duration of 
0.14 seconds and left axis deviation. Patients who 


develop ORS prolongation with an acute myo- 
cardial infarction may have a mortality of 46% 
or higher. This may not be due to complete 
heart block. The usual cause of death in these 
patients is left ventricular failure manifested as 
congestive heart failure, cardiogenic shock, or 
pulmonary edema. This patient sustained an 
acute anteroseptal myocardial infarction with 
complete right bundle branch block and left 
anterior hemiblock. This ECG speaks for severe 
coronary artery disease and also helps explain 
why so many of these patients die in the acute 
phase of the myocardial infarction with left ven- 
tricular failure. A careful review of the patient’s 
old hospital record would be important since his 
problem now is non-cardiac. Those patients who 
survive this attack may be in danger of complete 
heart block or sudden death. The data in the 
literature is incomplete on this point. His bundle 
recording may be helpful in these patients. In 
one series 8 of 1 1 patients with a prolonged H-V 
interval died while only one of three patients 
with a normal H-V died. The H-V would reflect 
trifasicular disease in these cases. (Lichstein et al 
Amer. J. Cardiol. 32:913-918, 1973). Most authors 
would recommend pacemaker implantation per- 
manently while recognizing the yield would be 
small because of the accompanying severe left 
ventricular disease. 



222 


Illinois Medical Journal 



Rehabilitation Of the Patient 
With Chronic Low Back Pain 

(Continued pom page 190) 

tion insurance carriers need to learn this, too. 

Our own experience has shown us that a 
comprehensive program of evaluation and treat- 
ment, as spelled out in this paper, does help the 
vast majority of our patients with chronic low 
back pain. However, it must be emphasized 
that the physician must exercise a great deal 
of patience and persistence if he is to achieve 
successful outcomes. Obviously, for the patient, 
the reward is worth the effort invested. ■< 

References 

1. Kottke, F. J.: “Evaluation and Treatment of Low Back 
Pain Due to Mechanical Causes.” Arch. P.M.&R. 42-6: 
426 June, 1961. 

2. Fordyce, W. E.: Psychology, “Social Work and Medi- 
cine.” Arch. P.M.&R. 52-9:402 September, 1971. 

3. Inman, V. T., and Saunders, J. B. de C. M.: “Referred 
Pain from Skeletal Structures.” J. Nerve and Mental 
Diseases 99:660 May, 1944. 


October Is Immunization 
Action Month 

( Continued from page 209) 

enhanced if the clinics are supported by the 
local medical society, in that private physicians 
are more likely to recommend acceptance by 


parents, respond better to possible complaints 
of reactions to the vaccine, and actively partici- 
pate by staffing clinics or signing a standing 
order and serving as emergency medical resources 
for clinics where needed. 

In an effort to make parents of young children 
more aware of the importance of complete im- 
munizations, intensive educational, information- 
al and motivational programs will be conducted 
throughout the state during “Immunization Ac- 
tion Month.” The primary purpose of the cam- 
paign will be to increase immunity among the 
inadequately immunized, or unimmunized pre- 
school-age population. 

The Illinois Immunization Program is plan- 
ning to distribute posters, brochures, immuniza- 
tion record cards, bookmarks, television and 
radio public service announcements, and has 
made arrangements with several dairies to print 
the recommended immunization schedule on the 
sides of milk cartons. 

It is expected that as a result of this massive 
public awareness campaign, private practitioners 
and local health departments will experience an 
increased number of requests for measles, rubel- 
la, polio and DPT/Td immunizations. “These 
activities,” are designed eventually to preclude 
the need for outbreak control measures by en- 
suring that each child receives needed immuniza- 
tions at the earliest time they are indicated. ◄ 


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for September, 1971 


223 


Legislative Report ( Continued from page 198) 


ISMS. Tabled in House. 

Rate Review (S.B. 1625) : Create an Illinois 
Health Finance Commission to regulate rates 
charged by state hospitals, extended care facili- 
ties and surgicenters. Referred to Senate Public 
Health Committee. 

Protection for Newborn (S.B. 1214) : 

Amend the Illinois Insurance Code to recognize 
the newborn as a person, and outlaw insurance 
policies containing disclaimers of coverage for 
the newborn. This ISMS proposal was assigned 
to the Senate Rules Committee . 

Medical Research (S.B. 1670) : Require 
state regulation of all medical research through 
a Research Review Committee, and mandate 
that possible side effects of research by explained 


to all human subjects. Tabled In House. 

Student Loans (H.B. 2757 & 2805): Pro- 
vide $400,000 for loans to medical students who 
agree to practice at least four years in physician- 
short areas of Illinois designated by the Depart- 
ment of Public Health. The loans program is on 
the House Interim Study Calendar, and the ap- 
propriation is under study by the House Com- 
mittee on Human Resources. 

Drivers License Advisory Board (S.B. 
1643) : Create within the Department of Public 
Health a Drivers License Medical Advisory 
Board to establish standards relating to physical 
conditions affecting a driver’s ability to safely 
operate a vehicle. Under study by Senate Public 
Health Committee. ◄ 


Conference Workshop On 


DRUG and ALCOHOL DEPENDENCIES 


October 4, 1974 
Ramada Inn, 
Bloomington, III. 


October 5, 1974 
Union, Illinois State University, 
Normal, III. 


Principal Discussant: George R. Gay, M.D., Director of Clinical Activities, 

Haight-Ashbury Free Medical Clinic, San Francisco 


Physicians, school nurses, school 
counselors, school administrators, 
allied health personnel, emergency 
department personnel, pharma- 
cists, enforcement (youth) officers, 
community workers and interested 
persons are invited to attend one 
or both days of the workshop. 


Subjects to be discussed include: 

The Abusive Substances Problem 
in the Schools 

The View of Enforcement Officials 
Teaching About Dependencies 
What To Do Until The “Doctor Ar- 
rives 

Drugs and the Law 
What is Dependency? 


Advance registration will be accepted until September 27, 1974. For information, write or pnorse, Illinois 
State Medical Society, Division of Scientific Services, 360 N. Michigan Ave., Chicago 60601; 312-782-1654. 


224 


Illinois Medical Journal 



Chicago Chapter — AAMA Presents 
1974 Annual Symposium 

66 From the Woman’s Point of View” 


Wednesday, October 16, 1974, McCormick Inn 
23rd and the Lake Chicago 


8:15 A.M. Registration, rolls and coffee 

8:50 A.M. Welcome, Mrs. Florence Peery, 
President, Chicago Chapter 

9:00 A.M. Mr. Ronald E. Przybylski 

Clinical Information Systems 
Salesman, Ames Company 

9:15 A.M. Dr. Helen Wilks 

Diabetes Foundation of Greater 
Chicago 


9:45 A.M. Dr. Robert C. Stepto, Chairman, 
Department of Obstetrics and 
Gynecology, The Chicago Medi- 
cal School “Menopause and the 
Myths and Facts about Hysterec- 
tomies.” 


10:15 A.M. Dr. Maceo R. Ellison, Associate 
Professor of Medicine, The Chi- 
cago Medical School 
“Hypertension” 

11:00 A.M. Judy Schuppien 

Rape Crisis Line 

11:45 A.M. Dr. Jack C. Berger, Psychiatrist 

“Emotional Aspects of Meno- 
pause, Hysterectomy and Rape.” 


1.00 P.M. Luncheon, Dr. Thomas R. Har- 
wood Master Of Ceremonies 


2:00 P.M. Airs. Dorothy Ritchey, Chicago 
YMCA 

Yoga Demonstration 

2:30 P.M. Door Prizes 

Registration $8.50 
Non-Members $9.00 
(includes luncheon) 


“From the Woman’s Point of View” — 1974 Annual Symposium, Chicago Chapter, Wednesday, October 16, 1974 — 
McCormick Inn, Chicago 

Registration — $8.50 non-Members — $9.00 

NAME CHAPTER 

ADDRESS CITY STATE ZIP 

EMPLOYER 

Make checks payable to CHICAGO CHAPTER — AAMA, 1974 Symposium. Send to Mrs. Bonnie Harper, 12434 South 
Yale Avenue, Chicago, 60628. Reservations Deadline: October 11, 1974. 


for September, 197-i 


225 


Primary Ovarian Pregnancy 

( Continued fro?n page 188) 

blood clots. Several placental villi were noted. 
Section revealed uterine tube with its charac- 
teristic mucosal surrounded by connective tissue 
and slightly dilated blood vessels. 

Diagnosis: Ectopic pregnancy of ovary. Uter- 
ine tube, no pathological diagnosis. 

The course of the patient’s illness after the 
operation was uncomplicated and left the hos- 
pital after a week in an excellent condition. ◄ 

References 

A complete bibliography for “Primary Ovarian Preg- 
nancy” may be obtained by writing the Illinois Medical 
Journal, 360 N. Michigan Ave., Chicago, 60601. 


Renal Tumor 

(Continued from page 207) 

chance that this was a benign lesion. The ex- 
ploratory procedure was modified on the basis of 
the X-ray study so that we looked at the lesion 
first. If the lesion had demonstrable neovascular- 
ity we would secure the pedicle and often remove 
the kidney and lesion on the basis of the clinical 
history and X-ray studies with further evaluation. 
Dr. John Beal: So you think that all cysts should 
be explored? 

Dr. Grayhack: No, not all of the avascular 
masses. I think it depends upon the patient’s 
general condition, but if the patient’s general 
condition is satisfactory, exploration is preferable 
in our opinion. 

Dr. Battifora: What was the nature of the fluid? 
Dr. Grayhack: It was clear. The cystic portion 
of the lesion looked like a simple serous cyst. Al- 
though tumors with significant necrosis are not 
uncommon, association of carcinoma of the kid- 
ney and typical serous cyst are rare. 

Dr. Harold Method: With the operative diag- 
nosis of simple cyst, what did you think caused 
the hematuria? 

Dr. Grayhack: She had a positive urine culture 
on cystoscopy and she had a classic cystoscopic 
appearance of hemorrhagic cystitis. The cysto- 
scopy did not disclose a neoplasm, but the pa- 
tient did have submucosal hemorrhages. With 
this finding, the patient’s symptoms, and the 
positive urine culture, it seems likely that the 
bleeding was from the lower urinary tract. 


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Twin Oaks PI. , Joliet • Call: 725-3777 


COOK COUNTY 

Graduate School of Medicine 

CONTINUING EDUCATION COURSES 
STARTING DATES, 1974 

SPECIALTY REVIEW COURSES IN HEMATOLOGY, INFECTIOUS DIS- 
EASES & NEPHROLOGY, Sept. 30 
SPECIALTY REVIEW IN SURGERY, PART 1, Sept. 30 & Nov. 4 
SPECIALTY REVIEW IN MEDICINE, RECERTIFICATION, October 14 
SPECIALTY REVIEW IN OBSTETRICS & GYNECOLOGY, Oct. 28 
SPECIAL COURSE IN GYNECOLOGIC PATHOLOGY, Oct. 14 
STATE & NATIONAL BOARD REVIEW, Basic & Clinical, Oct. 14 
& 20 

MANAGEMENT OF COMMON FRACTURES, One Week, Oct. 28 

BASIC ELECTROCARDIOGRAPHY, One Week, Oct. 28 

BASIC INTERNAL MEDICINE, One Week, November 11 

FAMILY PRACTICE REVIEW, One Week, November 4 

DIAGNOSTIC RADIOLOGY. One Week, October 7 

PSYCHIATRY FOR THE MEDICAL PRACTITIONER, 4 Days, Oct. 7 

SEXUALITY FOR THE PHYSICIAN, One Week, Oct. 21 

PRE & POSTOPERATIVE CARE OF PATIENTS, 4 Days, Oct. 29 

BLOOD VESSEL SURGERY, One Week, November 18 

ADVANCES IN OBSTETRICS & GYNECOLOGY, One Week, Nov. 18 

Information concerning numerous other continuation 
courses available upon request. 

Address: 

REGISTRAR, 707 South Wood Street, 
Chicago, Illinois 60612 


226 


Illinois Medical Journal 


Physician Recruitment Program 


In an effort to reduce the number of towns in Illinois needing physicians, the Physician Recruitment Program and the Doctor's 
Job Fair, are publishing synopses in the Journal. 

Physicians who are seeking a place to practice or who know of any out-of-state physicians seeking an Illinois residence are 

asked to notify the Program. 

Any areas wishing to be listed should contact: Mrs. E. Duffy, Physician Recruitment Program, ISMS, 360 North Michigan 
Ave., Chicago, 60601. 


ALEDO: Mercer County, 17,000 population, needs addi- 
tional family physicians. 4 active physicians at present. 
General acute hospital in Aledo. High quality medical 
care economically rewarding. Thirty miles from met- 
ropolitan quad-city area. Good small community for 
family living. Contact: Shirley Lindberg or Monty 
McClellan, M.D., 308 NW Fourth Street, Aledo, 61231, 
309/582-5156. (10) 

BLOOMINGTON: General Practitioners, Internists, 
Pediatricians and a Surgeon needed to help establish 
a multi-specialty clinic in a new Erdman Building. 
Corporate practice with all the usual benefits. Contact: 
Paul G. Theobald, M.D., #1 Medical Hills Dr., Bloom- 
ington, 61701, 309/828-6051. (10) 

CHARLESTON: Small midwestern University Health 
Service serving 8,000 students, 4% day week; no after 
hours or weekends. Perfect for post-retirement. Five 
weeks vacation and one week for medical meetings. 
Life insurance, health insurance, and University Re- 
tirement System. Contact: Director, Health Service, 
Eastern Illinois University, Charleston, 61920, (217) 
581-3013. (10) 

CHENOA: Rural area, 100 miles south of Chicago on 
1-55. Looking for one or two physicians to do family 
practice. Hospital facilities nearby. Financial assistance 
and office space can be arranged. Contact: R. J. Walk- 
er, National Bank of Chenoa, Chenoa, 61726, 815-945- 
2311. (10) 

CHICAGO: Board Certified or eligible, Internal Medi- 
cine, Illinois Registration. Medical Center, providing 
preventive and therapeutic medical care with other 
specialists and diagnostic services on premises. Ad- 
ministrative Ability an Asset, Salary Open, Commen- 
surate with background and experience. Call Collect: 
William A. Hutchison, M.D., Union Medical Center, 
1657 West Adams, Chicago, 60612, (312) 829-1134. (10) 

CHICAGO: General Practitioner - full time; centrally 
located, with no weekends or nights; work on standards 
for rating disability; evaluation of medical impair- 
ment. U.S. Railroad Retirement Board, Attention: J. 
E. Schwartz, Chief D&H, 844 Rush Street, Chicago 
60611. (1) 

CREVE COEUR: M.D. URGENTLY NEEDED as an 
associate in a very active practice in the Peoria area, 
hospitals. Present M.D. wishes to retire soon and is 
Family or General Practice within six miles of three 
hospitals. Present M.D. wishes to retire soon and is 
concerned with his patients. Financial arrangements 
and over-all needs negotiable. Only those seriously 
interested in private practice call collect 309-699-8022 


or 309-699-5525 or write William Long, M.D., Creve 
Coeur, 111, 60601. (2) 

DEKALB: Northern Illinois University Health Service 
needs Internist; General Practitioner; and Gynecol- 
ogist or practitioner with wide experience in gyne- 
cology and family planning. Reduced paper work, 
better hours, inquiring patients, new health care de- 
livery systems, and University atmosphere provide 
interest. Illinois license required. Equal Opportunity 
Employer. Write L. W. Akers, M.D., Director. NIU 
Health Service, DeKalb 60115. (10) 

FLORA: Population 6,000, Patient-drawing area larger. 
G. P., Internist, Pediatrician. Group or solo. Office 
space can be arranged to suit your needs. Unusually 
well-equipped small hospital with excellent lab and 
X-ray facilities and ICU. Nearby specialty consultants. 
Fine school system and availability of homes. For 
information contact: Administrator, Clay County Hos- 
pital, Flora, 62839, 618-662-2131. (10) 

GENESEO: Family Practice; Ped., Ob-Gyn, Int. Medi- 
cine who will also do General Practice. Population 
7,000 serving area 30,000 on Interstate 80, 2% hrs. 
from Chicago, 25 miles from Quad-Cities metropolitan 
areas, over 300,000. Safe, ideal, small city living, 110 
bed ultra-modern hospital, excellent schools, recrea- 
tional facilities. Hospital has just completed construc- 
tion of two new modern doctor’s offices on hospital 
property which are available immediately. Guarantee 
monthly gross income. Clement G. McNamara, 210 W. 
Elk St., Geneseo, 61254. Call collect (309) 944-6431. (10) 

GENEVA: GP’s or Internists - Outstanding area with 
unlimited practice opportunities needs you to grow 
with us. Ideal location for family living in the heart- 
land of the Midwest. Geneva offers the charm of 
“new England” background - and all only 35 miles 
from the cultural and medical education advantages 
of Chicago. Contact: Peter G. Gilbert, M.D. c/o Com- 
munity Hospital, Geneva 60134 (312-232-0711). (1) 

HARVARD: Population 5,200, estimated trading area 
20,000. Three physicians at present, previously five. 
Center of rapidly growing and financially sound area. 
65 miles northwest of Chicago, 30 miles east of Rock- 
ford. Contact: J. M. Holcomb, Harvard Com. Hosp., 
Grant & McKinley Sts., Harvard, 60033. (10) 

KEOKUK. Expanding Clinic with new offices in prog- 
ressive general hospital offers exceptional opportunity 
to G.P.’s Internists/Cardiologists, General Surgeon 
willing to do some G.P. Guaranteed salary, no invest- 
ment. Group membership one year or less. Surgeon, 
G.P., OB/Gyn, Pediatrician. Ideal environment. Com- 
munity 16,000; service area 50,000. Contact Fred 


for September , 1974 


227 


Shrimpton, Administrator, St. Joseph Hospital, Keokuk, 
Iowa 52632, 319-524-2710. (12) 

LIBERTYVILLE — Thirty-Five miles northwest of Chi- 
cago. Population 12,000 — serving 40,000. Group practice 
of Family Physicians. Affiliated with a 175 bed hospi- 
tal. Corporation benefits. Salary guarantee. Beautiful 
country for lake sports. Contact: Dr. Mark Fields, 716 
S. Milwaukee Rd., Libertyville 60048, 312-362-1390. (10) 

METROPOLIS: Physicians wanted. Complete office 
facilities. Financial assistance available. Modern, well 
equipped hospital serving tri-county area in scenic 
southern Illinois. Contact: Charles Russell, Adminis- 
trator, Massac Memorial Hospital, Metropolis, 62960, 
(618) 524-2176. (10) 

MONMOUTH: Services area population 30,000. Open- 
ing for Family Practice and OB-GYN. Modern well- 
equipped hospital — 141 beds. Near Highways 1-74 & 
1-80. Daily rail to Chicago. Flight service available. 
Safe place to raise family. Near medical school, liberal 
arts college. Contact: Roger E. Gurholt, 1000 W. 
Harlem Ave.. Monmouth, 61462. 309-734-3141. (10) 

MORRIS: Associate wanted - internist, GP, surgeon; 
growing general practice near Chicago - population 
9,000, lovely clean city. Large new office newly 
equipped. Hospital close. Attractive financially. Keep 
all you earn Share office overhead only. Contact: 
Dr. V. L. Hicks, Bedford Plaza Center, Morris 60450 
(815-942-4067). (1) 

NASHVILLE: Board certified or eligible surgeon - 
must be willing to do general practice - 3,000-14,000 - 
72 bed JCAH hospital - 50 miles east of St. Louis - 
excellent schools and churchs - outstanding area to 
live - assistance available - Contact: T. K. Janssen, 
603 South Grand Ave., Nashville 62263 (618-327-8236) 
( 1 ) 

PITTSFIELD: Need family practitioners and sur- 
geons interested in locating in rural community area. 
Population 4100; area 18,000. Excellent opportunity 
for someone wanting to practice in a rural community. 
Located between Jacksonville and Quincy, on High- 
way 54 and 36. Contact Dr. T. C. Bunting, Illini 
Community Hospital, Pittsfield 62363. AC 217-285-2141 
or 217-285-2113. (12) 


ROLLING MEADOWS: Population 20,000. Five phy- 
sicians at present. 25 miles from Chicago. Loan avail- 
able to start practice. One mile from 450 bed Northwest 
Community Hospital. Good office facilities for one or 
more Family Practitioners, Internists, Pediatricians. 
Nearby College. Contact: Keith G. Wurtz, M.D., 1430 
N. Arlington Hts., Arlington Hts., 60004 (312-255-3313) 
(1) 

SAVANNA: Pediatrician, Internist, or General Prac- 
titioner. Illinois community of 5,000 population on 
Mississippi River. 40-bed open staff hospital; excep- 
tional recreational facilities; excellent schools and 
churches of all denominations. Option to practice 
alone or in partnership. Contact: William J. Dayton, 
202 Meadowview Knoll, Savanna, 61074, 815-273-2755. 
(10) 


SHELBY VILLE : Population 6,000 — drawing population 
22,000. New eight man medical ctr. recently opened 
and attached to 100 bed hospital. Object to secure a 
medical practice group. Central location within com- 
muting distane of Springfield — 60 miles, Decatur 35 
miles & St. Louis 115 miles. Located on large lake rec- 
reational area. Contact: John Snyder, Shelby County 
Memorial Hospital, 1st & Cedar Sts., Shelbyville, 62565, 
217-774-3961. (10) 

SPRINGFIELD: Emergency Room Physician, Join 4 
permanent staff physicians at a progressive 580 bed 
general hospital in Central Illinois. Attractive salary 
and benefits. Enjoy the relaxed atmosphere in this 
92,000 population city. Practice medicine without the 
worries of office employees and accounting. Contact 
Arthur Lindsay, M.D. Memorial Medical Center, 1st 
and Miller Streets, Springfield, Illinois 62705. 217-528- 
2041. (12) 

SPRINGFIELD: Emergency Room Physician, Join 4 
permanent staff physicians at a progressive 580 bed 
general hospital in Central Illinois. Attractive salary 
and benefits. Enjoy the relaxed atmosphere in this 
92,000 population city. Practice medicine without the 
worries of office employees and accounting. Contact 
Arthur Lindsay, M.D. Memorial Medical Center, 1st 
and Miller Streets, Springfield, Illinois 62705. 217- 
528-2041. (1) 


Chiropractic study slated 


An agenda for a study of chiropractic was pre- 
pared early this month by a planning committee 
of neuroscientists, biomechanics specialists, chiro- 
practors, and medical investigators. The study 
will be conducted primarily under the auspices 
of the National Institute of Neurological Dis- 
eases and Stroke. 

The study was called for early this year when 
Congress passed a Health, Education, and Wel- 
fare Dept, appropriations bill after chiropractic 
coverage had been included in Medicare. 


The broad study of the fundamentals of chiro- 
practic will culminate in an international scien- 
tific conference in February, devoted to discus- 
sion of the research status of spinal manipulation. 

At the time the study was proopsed, H. Thom- 
as Ballantine, M.D. chairman of the AMA Com- 
mittee on Quackery, said he hoped it would 
determine “once and for all whether chiropractic 
is the valid ‘separate and distinct’ health care sys- 
tem it claims to be.” 

(AMA News , Aug. 1974) 


228 


Illinois Medical Journal 


Obituaries 


““Berry, Roy, Lebanon, died July 28 at the age of 88. 
Dr. Berry was a past president of the Madison County 
Medical Association and a past treasurer and trustee of 
McKendree College in Lebanon. 

“Berwanger, Willard, Glen Ellyn, died July 31 at the 
age of 71. He graduated from the University of Wis- 
consin in 1929. 

“Champagne, Carl, Oak Park, died July 19 at the age 
of 71. He graduated from Loyola University in 1928. 
Dr. Champagne was a staff physician at Mother Cabrini 
Hospital for 42 years. 

“Cohen, Abraham, Peoria, died June 30 at the age of 
70. Dr. Cohen graduated from the University of Illinois 
in 1928. He was a past president of the Methodist Hos- 
pital Medical Staff. He also served on the Boards of the 
Florence Critton Home and Crippled Childrens Center. 

“Coogan, Thomas, Chicago, died June 28 at the age 
of 73. He graduated from the St. Louis University 

School of Medicine in 1927. He served as a member 
of the staff of St. Luke’s Medical Center. Dr. Coogan 

also served as physician to Mayor Daley before suc- 

ceeded by his son. Dr. Coogan was associated with the 
University of Illinois Medical Center and served on the 
faculty of the Northwestern University School of Medi- 
cine. 

“Frank, William W., Hinsdale, died July 2 at the age 
of 72. He graduated from the College of Medical 

Evangelists in 1927. Dr. Frank had been on the staff 
for 46 years at the Hinsdale Hospital. 

““Heyman, Bernard, Peoria, died July 7 at the age of 
77. Dr. Heyman graduated from General Medical Col- 
lege in 1924. He practiced medicine for more than 50 
years. Dr. Heyman was also also a surgeon and active 
on the medical staff of Proctor Hospital. 

“Higgins, Melvin, Harvey, died July 5 at the age of 62. 
He graduated from Rush Medical College in 1938. Dr. 
Higgins has been a general practitioner in Harvey for 
35 years. 

““Hospers, Anthony, Western Springs, died July 4 at 
the age of 80. He graduated from the University of 
Illinois in 1922. 

“Kowalski, Leonard, Melrose Park, died July 21, at the 
age of 56. He graduated from Loyola University Stritch 
Medical School in 1943. Dr. Kowalski was a former head 
of the anesthesiology department at Mercy and Holy 
Cross Hospital. 

““Mills, Morton, Olympia Fields, died June 26 at the 
age of 75. Dr. Mills lias been a general practitioner for 
over 50 years. He graduated from the University of 
Illinois in 1924. 

““Trammel, Henry, Chicago, died July 27 at the age 
of 81. Dr. Trammel received a degree in medicine from 
Northwestern University in 1918. He also practiced 
medicine at the Kansas City, Mo. General Hospital and 
was an attending physician at Provident Hospital for 40 
years. 


““Slobe, Frederick, Florida died July 19 at the age of 
81. He graduated from Rush Medical School in 1917. 
Dr. Slobe was a past president of the Industrial Medical 
Association, Fellow American College of Surgeons and 
the International College of Surgeons. He was also a 
former Chairman of the Illinois Board of Mental Health 
Commissioners. 

“Wolf, Glenn, Naperville, died July 17 at the age of 
60. He graduated from the University of Illinois in 
1949. Dr. Wolf was a founder of the Edward Hospital 
and Wolf Medical Group and president of the DuPage 
County Tuberculosis Center and Treatment Board. 

° Indicates ISMS member 

00 Indicates ISMS member and Fifty Year Club member 


Canada Limits 
Liability Suits 

The Canadian Supreme Court has handed 
down a landmark decision that makes medical 
malpractice suits invalid in that country if not 
filed within a year after injuries are suffered. 

The unanimous judgment was rendered in an 
appeal by a Quebec hospital of a $20,000 damage 
award to a woman who had suffered x-ray burns 
in 1960. 

Previously, it was the opinion of the Canadian 
courts that a plantiff had 30 years to file suit 
against a doctor or hospital. The Canadian court 
system, however, historically has favored the 
medical profession in malpractice suits, so this 
latest ruling, legal experts say, does not come as 
a complete surprise. The typical physician in 
Canada rarely is threatened by a malpractice suit 
and pays only about $50 a year for malpractice 
insurance. 

In handing down the ruling, the Supreme 
Court pointed out that the 30-year concept had 
been based on the view that the legal relationship 
between a physician or hospital and a patient 
produced an implied contract to provide proper 
medical care. The Supreme Court, however, held 
that malpractice suits should fall under the cate- 
gory of personal injury rather than breach of 
contract. And, in ordinary personal injury suits 
in Canada, legal action must be filed within a 
year. 

The new ruling is expected to result in the 
dismissal of many suits now pending in Canadian 
courts. 

(AM A News, Aug. 12, 1974) 


for September, 1974 


229 


CLASSIFIED ADVERTISING 


Positions & Practice Opportunities 


IMMEDIATE FAMILY PRACTICE OPENING— in two man clinic. Liberty- 
ville, Illinois, 35 miles northwest of Chicago. Initial salary and early 
partnership. Busy practice in small suburban town. Call collect— 
Dr. Lawrence C. Day (312) 362-1447. 


ATTENTION PHYSICIANS! CHICAGO MEDICAL CENTERS-Welfare 

area in need of physicians. Please contact: Mr. Robert Fields (312) 

236-2555. 


GENERAL INTERNISTS and GENERALISTS: For growing sub-sections 
of 45 man medical department, including allergists, psychiatrists, 
neurologists, all sub-specialties and expanding primary care section. 
Multispecialty group of 120. Large patient population and area re- 
ferral. Functioning HMO. Generous salary and fringe benefits. Peace- 
ful setting near Wisconsin vacationland and cities. Good schools, 
cultural advantages. Junior College. Educational and research pro- 
grams. Liberal schedules, little practice pressure. New Clinic and 
hospital developing. Write or call J. L. Struthers, M.D., Marshfield 
Clinic, Marshfield, Wisconsin 54449. 


Immediate opening for Ob-Gyn and Internal Medicine, specialties 
to establish successful practice with 14-man multi-specialty group. 
Excellent group benefits; pension plan; modern clinic facilities; 
progressive community with excellent educational system includ- 
ing two colleges; city population 35,000; good recreational facilities; 
each specialty must be board eligible or certified. Contact: Business 
Manager, The Manitowoc Clinic, 601 Reed Avenue, Manitowoc, Wis- 
consin 54220. 


WHY FIGHT PSRO's, HMO's, AND ILLINOIS PUBLIC AID? Join us- 
minimal records, short hours, 5 weeks vacation, and 1 week medical 
meetings. Illinois University Retirement System, Health Insurance, 
and Life Insurance. Beginning salary $25,000 and negotiable. Call 
or contact Director, Health Service, EIU, Charleston, Illinois. Phone 
217-581-3013. 


FAMILY PRACTICE AVAILABLE about Sept. 1, 1974. Excellent set 
up with high earnings. Western suburb of Chicago. Write to Box 
834 c/o Illinois Medical Journal, 360 N. Michigan, Chicago, Illinois, 
60601. 


EXPERIENCED, BUSY G. P. seeking regular hours. Will consider a 
clinic, hospital E. R. or other. Write Box 833 c/o Illinois Medical 
Journal, 630 N. Michigan, Chicago, Illinois 60601. 


CASHMERE, WASHINGTON FAMILY PRACTICE opportunity in two- 
man office with four doctor week-end rotation. Scenic setting in 
orcharding valley on east edge of Cascades. Choice mountain and 
lake recreation and skiing. Vital community with quality schools. 
Excellent hospital facilities and cultural advantages in nearby 
Wenatchee. E. A. Meyer, M.D. (Iowa '50) ABFP, 303 Cottage 
Avenue, Cashmere, Wash. 98815. Tel.: (509) 782-1541. 


EMERGENCY ROOM PHYSICI AN-Need fifth man to join four full- 
time physicians interested in acute care medicine. Regular hours, 
excellent fringe benefits, salary negotiable. 410-bed hospital (com- 
munity). Medical School affiliation. ER group incorporation under 
consideration. Contact: John Edmundson, V-P Administration, Rock- 
ford Memorial Hospital, 240 North Rockton Avenue, Rockford, 
Illinois 61101. 


FAMILY PHYSICIANS— U nique practice opportunity in an incor- 
porated 28 man group in east central Wisconsin. New clinic 
facility across the street from 450 bed hospital. Ideal cultural and 
recreational setting. Opportunity to develop special interests in 
acute and ongoing adult care and/or industrial medicine. Equal 
stockholder in one year. Excellent pre-tax fringes. Write Box 836. 
Illinois Medical Journal, 360 N. Michigan, Chicago, III. 60601. 


Large physician group has immediate positions available for full- 
time or part-time Clinic and Emergency Room work. Several loca- 
tions in Chicago and Central Illinois. Salary plus liberal benefits 
average over $20.00 per hour for full-time work. Scheduling flexible 
to meet individual needs. Contact Gene Gaertner, M.D., 153 W. 
Lake, Bloomingdale, III. 312-627-3404. 


Full Time Medical Officers Major Chicago— area hospital has im- 
mediate opening for General Practioners and other specialists; 
Joint Commission accredited Medical Center; attractive benefits; 
competitive salary; all shifts available (8-4; 4-12; 12-8); Medical 

coverage needed for acute care, rehabilitation, skilled nursing and 
intermediate care levels; Excellent opportunity for professional 
advancement. Send curriculum vitae to: Ms. T. Higgins, Personnel 
Manager, Oak Forest Hospital, 15900 South Cicero Avenue, Oak 
Forest, Illinois 60452. 


VACANCY— Admitting, primary care, personnel physician. Desire 
physician interested in academic university affiliation, preferably 
board certified in family practice. Five day week, nites free. VA 
benefits and retirement. Salary $26,000 to $32,000 depending on 
qualifications. Nondiscrimination in employment. Inquire: Chief of 
Ambulatory Care, VA Hospital, Iowa City, Iowa 52240. (Phone 
319-338-0581). 


GYNECOLOGY CLINIC PHYSICIAN for large university health ser- 
vice. Primarily office gynecology and family planning practice. 
Must have residency or extensive experience in specialty. No ob- 
stetrics or major surgery. Must be interested in preventive medicine 
and health education activities and programs and in working with 
college students. Illinois license required. Start anytime between 
August 1974 and January 1975. Equal Opportunity Employer. L. W. 
Akers, M.D., Director, UHS, N.I.U., DeKalb, Illinois 60115. 


PRIMARY CARE PHYSICIAN for large university health service. 
Excellent facilities, liberal fringe benefits, good geographic location. 
Illinois license required. Equal Opportunity Employer. L. W. Akers, 
M.D., Director, UHS, N.I.U., DeKalb, Illinois 60115. 


INTERNIST— To serve as Chief of Clinical Medicine for large uni- 
versity health service. Must be interested in new health care 
delivery systems, preventive medicine, health education, as well as 
clinical and consultative work. Illinois license required. Equal Op- 
portunity Employer. L. W. Akers, M.D., Director USH, N.I.U., DeKalb, 
Illinois 60115. 


PHYSICIAN FOR ACUTE ILLNESS DEPARTMENT and Emergency Room. 
Become a part of an expanding, dynamic multispecialty clinic in 
Midwest university community. Excellent salary, benefits. Write or 
call Medical Director, Carle Clinic, Urbana, Illinois 61801. Phone 
(217) 337-3239. 


NEWBERRY— (Luce County)— Needed, general practitioners in beautiful 
Upper Penninsula Hospital, 60 miles west of the Mackinac Bridge. 
A fully accredited hospital with an excellent staff. New Medical 
Arts Building recently constructed. Excellent opportunity to start a 
practice. For a good place to live and bring up children, come to 
Newberry Michigan. Fringe benefits available. 

CONTACT: D. J. Massoglia, Helen Newberry Joy Hospital, Newberry, 
Ml. 49868. Phone (906) 293-5181. 


FOR SALE, LEASE OR RENT 


BARRINGTON, ILL.: Medical suites available in a newly completed 
multi-specialty Center just a few blocks from the future Good 
Shepherd Hospital. Ample paved parking facing Hwy. 14. All suites 
are 800 sq. ft., luxuriously finished, and absolutely independent. 
Call: (312) 381-4160 or 381-5800, or write to Box 829 , c/o Illinois 
Medical Journal, 360 North Michigan Ave., Chicago, III. 60601. 


OFFICE FOR RENT: Suitable for psychiatrist or psychotherapist. 

Contact: Dr. Gamm, c/o C. Swartz, 532 Pleasant, Highland Park, 
III., 60035, 433-0819, or call Ans. Serv. at (312) 787-7480. @$150/ 
mo. located at 664 N. Michigan Ave., Chicago. 


HOUSE, OFFICE, EQUIPMENT, and FAMILY PRACTICE, for sale in 
Chicago southwestern suburb. Affiliation with fine hospitals. Practice 
grosses $100,000 plus, per year. Office building 1300 square feet, 
four (4) examining rooms. Separate, well-appointed 100-year old 
Victorian house, beautifully landscaped. Call collect (312) 485-1248. 


VACATION ON SANIBEL ISLAND, FLORIDA. Luxurious condominium 
on Gulf Beach; two bedrooms, two baths, sleeps six; air-condi- 
tioned, pool, porch; minimum rental one week. Box 194, Ann 
Arbor, Michigan 48108. 

FOR RENT 4010 W. MADSON STREET-OFFICE SPACE available for 
Medical Doctors. No need to buy a practice. We have plenty of 
patients for you. 1-2-3 Room Suites. Immediate Possession. Call: 
Illinois Property Management Corp., Mr. R. M. Ryan, Agent. 312- 
VA 6-4438 or 379-1133. 


12 ROOMS— Suitable for doctors' offices, laboratory, dentists, etc. 
Available immediately. 55 East Washington. 332-2072. 


KEY BISCAYNE, FLA.— lux. 1 bdrm. oceanfront condo, accom. 4 
people, color T.V., marbled IV 2 baths, balcony overlooking 
pool and beach, sauna, tennis, Golf course, shopping one block 
away 15 min. to Miami Beach & airport. V.P. Tumasonis M.D. 
2454 W. 71st str., Chgo., III. 60629, 434-2123. 


MEDICAL OFFICES AVAILABLE 

New — Reasonable — Air Conditioned. Sufficient Office Space for 
clinic potential. Good Area — Close to Hospitals — Southwest. 
Call Mr. Kaufman or Mr. Orzoff. 252-2300. 


3333 W. PETERSON MEDICAL & DENTAL BUILDING-5 room suite 
available, divided into examining rooms, consultation room,, secre- 
tarial & lab space, handsome reception room with receptionist ser- 
vice available. Immediately available. Phone IR 8-8785. 


MEDICAL ARTICLES FOR SALE 


NEED EQUIPMENT or SUPPLIES? ? Your new examining rooms are 
in stock: Otoscopes, ophthalmoscopes, blood pressure equipment, 

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DISPOSABLES CATALOG write or call: THE PHYSICIANS MART, 5637 
West North Avenue, Chicago, Illinois 60639, Telephone: (312) 237-5343 


230 


Illinois Medical Journal 



Blue Shield States Position on NHI 

Portions of a statement delivered by Mr. Ned F. 
Parish, President of the National Association of 
Blue Shield Plans, before the Ways and Means 
Committee of the U. S. House of Representatives 
on May 31, 197J), are reprinted here. Speaking out 
for the 71 Blue Shield Plans which protect 72 
million private subscribers and serve an additional 
12 million persons thru government programs, Mr. 
Parish defended the private system of medical care 
prepayment as opposed to nationalized health in- 
surance. 

In his statement he cited examples of how Blue 
Cross and Blue Shield are conducting progressive 
programs in the health care field and emphasized 
that any federal action taken on health insurance 
should include a working partnership with the 
private insurance sector: 

“Mr. Chairman, we have been constructive in 
the past and we expect to continue to be. While 
the Congress considered Health Maintenance Or- 
ganizations for four years, Blue Cross and Blue 
Shield were building them. While the Administra- 
tion labors to implement Professional Standards 
Review Organizations, we are actively trying to 
help. The National Association and its member 
Plans are developing uniform accounting systems, 
utilization review programs, local pricing of ser- 
vices for out-of-state subscribers, and other tech- 
nical advances to strengthen our system. With 
Blue Cross, we have spent millions of dollars in 
the past several years to develop uniform systems 
capable of handling, with increased efficiency, the 
substantially larger claims volume that can be ex- 
pected from a major national priority on improved 
health financing. We have spent additional mil- 
lions on containing health care costs, and on 
educating the public to care for its own health. 

“The role of the private carrier in America has 
been absolutely unique in the world. No other 
country has developed the strong viable private 
insurance system that America has created. 

“Blue Shield has in the past and again asserts 
that there are significant problems that private 
carriers have not been able to solve. Some of them 
can never be resolved without the active partici- 
pation of government. We have been on record 
for almost four years as believing that a closer 
working partnershio is needed between the insur- 
ance industry and the government. However, we 
want to emphasize the concept of partnership — of 
working together — as the logical and most produc- 
tive course. Preemption of the industry would 
create more problems than it would solve. 

“Some federal action is clearly necessary. We 


believe it should proceed in a working partnership 
with our industry and in accord with a few basic 
principles, which we would suggest as: 

“1. There should be maximum participation by 
the private sector, which has developed nearly all 
of the capacity which now exists in the actual 
administration of health benefits. To get the great- 
est benefit from the health financing industry, ex- 
cessive regulation and controls not directed at 
quality and efficiency of coverage should be 
avoided at all costs. 

“2. There should be free choice between pro- 
vider and patient, and a competitive market among 
carriers, within the constraints of standards for 
benefits and administration. 

“3. The public should have free choice of health 
care delivery systems. 

“4. Federal financing will be required for cover- 
age of the poor and the medically indigent. The 
private sector has no capacity to provide such fi- 
nancing without legislation. 

“5. Effective regulation of carriers with respect 
both to benefits and retentions is necessary. Tradi- 
tionally, this has been a state function, and regula- 
tions should continue to be implemented by the 
states. However, federal guidelines will be needed, 
and the federal government should have inter- 
vention authority if the states fail to act. 

“6. There should be minimum standards for 
basic coverage, and an opportunity for groups and 
individuals who wish protection beyond the mini- 
mum level to purchase complementary coverage. 

“7. There should be opportunity to integrate 
supplemental coverage with the basic coverage 
and administer it as one program, for economy 
and efficiency, and in order to provide first dollar 
benefits and the advantages of physician participa- 
tion as an alternative to cost sharing through co- 
insurance and deductibles. 

“8. Catastrophic coverage must be coordinated 
with basic coverage and should not be imple- 
mented as a ‘free standing’ program. In the 
absence of such coordination, it is essentially im- 
possible to define the point of catastrophe, and 
there is potential for enormous duplication of 
administrative effort. 

“9. An NHI program should be understandable 
from the outset in terms of its systems require- 
ments, in order to facilitate design of appropriate 
systems for its implementation. However, imple- 
mentation should be phased in, with maximum 
possible lead time, to permit orderly accommoda- 
tion of the staffing, training, software and hard- 
ware problems which will accompany implementa- 
tion, and which would be considerably exacerbated 
by a sudden massive eligibility for new benefits.” 


(This report is a service to the physicians of Illinois) 


ASK BLUE SHIELD . . . ABOUT MEDICARE 


LIMITATION ON LIABILITY OF BENEFICIARY AND PHYSICIAN 


A new section of the Medicare Act entitled “Lim- 
itation on Liability of Beneficiary and Physician” 
contains provisions on furnishing Part B services 
and supplies under an assignment agreement after 
October 30, 1972. Either liability for payment is 
assessed or waiver of liability allowed in Part B 
assigned claims because the services or items fur- 
nished were determined by the carrier to be "not 
reasonable or necessary or custodial.” 

Frequently referred to as the “Waiver of Liability 
Provision” of the Medicare Act, regulations im- 
plementing the provision were made effective in 
November, 1973 upon issuance of an Intermediary 
Letter to Part B carriers by the Department of 
Health, Education and Welfare, Social Security 
Administration. 

Before publication of the final regulations in the 
National Register, a brief summary of the interim 
instructions contained in the Intermediary Letter 
was published in the February 197 U issue of “Ask 
Blue Shield About Medicare” , Illinois Medical Jour- 
nal. A more comprehensive summary of the provi- 
sions is published herewith as information to the 
general medical community. Because of its length 
the summary will be published in successive issues 
of IMJ. 

INTRODUCTION 

Three basic aspects of Section 1879 of the 
Medicare Act determine whether the liability of a 
beneficiary will be limited or waived in Part B 
denial cases involving services of physicians and 
suppliers: 

(A) The denial is made because services ren- 
dered after October 30, 1972 are, under Medicare 
provisions, not reasonable and necessary or con- 
stitute custodial care ; 

(B) Payment is sought by the physician or sup- 
plier of services in an assignment agreement; and 

( C ) The beneficiary did not or could not reason- 
ably have been expected to know that the services 
are not covered. 

Where the liability of the beneficiary is limited 
because these conditions exist, the Medicare pro- 
gram will accept liability, i.e. make payment for 
the denied items or services, provided the physician 
or supplier of services did not know and could not 
reasonably be expected to have known that pay- 
ment for the items or services would not be made. If 
the physician or supplier had or could be expected 
to have had such knowledge, liability would not 
be waived. In any event, if the beneficiary knew or 
could be expected to have known that the services 
would not be considered reasonable or constituted 
custodial care, the ultimate liability will rest with 
the beneficiary, as well as the responsibility for 
payment to the physician or supplier. 

II. Determination of Services Not Reasonable and 
Necessary 

The new section of the Medicare Act provides 
for implementation of the waiver of liability issue 
only when claim denials are made for reasons that 


“services and items are not reasonable and neces- 
sary for the diagnosis or treatment of an illness 
or injury, or to improve the functioning of a mal- 
formed body member, or for custodial care”. 

The category of reasons for denial is apart from 
denials made under general Medicare exclusions. 

When a claim is denied by the carrier for rea- 
sons of “not reasonable or necessary,” but qualifies 
for review and hearing under the new section of 
the law, it must also be for a service or item that 
does not fall outside Medicare coverage. 

Some items and services are denied as not rea- 
sonable because their medical effectiveness has 
not been established for diagnosis or treatment of 
any kind of illness, injury or medical condition. 
Examples of such procedures would be colonic 
irrigation and cellular therapy. 

Other services and items may be recognized as 
effective in some circumstances but not in a par- 
ticular case for certain conditions. An example 
would be a physician’s daily visits to a patient’s 
home. Such visits might be reasonable and necessary 
for one patient but not covered for another when 
the diagnosis and condition does not medically 
warrant daily visits. 

The waiver provision does not apply to denied 
claims for medically unreasonable or unnecessary 
services or items when payment would be denied 
under another exclusion or an unmet coverage re- 
quirement. The following are examples of services 
or items that do not come under the waiver of 
liability provisions: 

(A) Personal Comfort Items: those within the 
category of items that do not meet the definition 
of durable medical equipment and cannot be 
covered even though they may seem medically 
necessary because of the patient’s condition. In 
some instances, items that are classified as durable 
medical equipment may be denied as not reasonable 
and necessary for a particular illness or injury and 
such denials may be considered for waiver of 
liability. Where liability is waived for durable 
medical equipment, the provision applies to rental 
for past periods or installments paid in those 
periods when the item was purchased; 

(B) Routine physical checkups, eyeglasses, eye 
examinations for the purpose of prescribing, fitting 
or changing eyeglasses, procedures to determine 
refractive state of the eyes, hearing aids or ex- 
amination of hearing aids, or immunizations. (Those 
services and items generally excluded under the 
program ); 

(C) Cosmetic surgery, or expenses incurred in 
connection with such surgery; 

(D) Services in connection with care, treatment, 
filling, removal or replacement of teeth or struc- 
tures directly supporting teeth; 

(E) Failure to meet a condition — such as drugs 
and biologicals that can be self-administered, un- 
necessary ambulance services, ambulance services 
partially denied because the trip exceeds covered 
limits. 

— CONTINUED IN NOVEMBER ISSUE — 


(This report is a service to the physicians of Illinois) 




Illinois Medical Journal 


OCTOBER, 1974 Vol. 146, No. 4 CONTENTS 


Special Article 


381 

Repeal of the Aurora Brand Interchange Agreement 
H. Michael Wild 

Reference Issue 

268 

ISMS Organization 

272 

Constitution and Bylaws 

(Index to Constitution and Bylaws . . . 283) 

284 

Policy Manual 

296 

County Society Officers 

305 

Councils of ISMS 

314 

Committees of the Board 

320 

ISMS Services 

333 

Medical Education 

334 

Paramedical Education 

340 

Illinois State Government and Agencies 

373 

Medical Legal Information 
(Index . . . 378) 

Presidents 

Page 

391 

Faulty Communication 
Fredric D. Lake, M.D. 

Surgical Grand Rounds 

383 

Stroke in a 19 Year Old Man 
John M. Beal, M.D. 

Viewbox 

392 

Computerized Axial Tomographv with the EMI-Seanner 
at Loyola University Medical Center 

Enrique Palacios , M.D., Behrooz Azar Kia. M.D . , and Leon Love, M.D. 


(Contents continued cn overleaf) 


lor October, 197f 


237 


CONTENTS (continued) 


Features 


242 

Editorial 

254 

Clinics For Crippled Children 

390 

Doctor’s News 

392 

Viewbox 

395 

Housestaff News 

396 

EKG of the Month 

397 

Pnlse of the Doctor’s Wife 

398 

ISMS Guide to Continuing Medical 
Education 

402 

Physicians Recruitment 

Staff 

Editor 

Theodore R. Van Dellen, M.D. 


Managing editor Richard A. Ott 

Assistant editor Joyce Gallagher 

Executive administrator Roger N. White 


(Cover bij Mike White l? Associates) 

PUBLICATIONS COMMITTEE 

Jacob E. Reisch, M.D., Springfield, Chairman 
Eugene T. Hoban, M.D., Oak Park 
A. Edward Livingston, M.D., Bloomington 
James A. McDonald, M.D., Geneva 
Warren W. Young, M.D., Crete 


Contributor in Surgery: John M. Beal, M.D., Chicago 
Contributor in Medical Progress: Harvey Kravitz, M.D., Skokie 
Contributor in Maternal Death Studies: 

Robert Hartman, M.D., Jacksonville 
Contributor in Pediatric Perplexities: Ruth A. Seeler, M.D., Chicago 
Contributor in Radiology: Leon Love, M.D., Maywood 
Contributor in Cardiology: John R. Tobin, M.D., Maywood 


ILLINOIS STATE 
MEDICAL SOCIETY 

360 N. Michigan Ave., Chicago, 60601 

OFFICERS 

Fredric D. Lake, M.D., President 
1041 Michigan Ave., Evanston 60202 
J. M. Ingalls, M.D., President-Elect 
502 Shaw, Paris 61944 
Harold A. Sofield, M.D., 1st Vice-President 
715 Lake Street, Oak Park 60301 
Robert Hartman, M.D., 2nd Vice-President 
1515A W. Walnut Street, Jacksonville 62650 
Jacob E. Reisch, M.D., Secretary-Treasurer 
1129 S. 2nd St., Springfield 62704 

HOUSE OF DELEGATES 

Andrew J. Brislen, M.D., Speaker of the House 
6060 S. Drexel Blvd., Chicago 60637 
James A. McDonald, M.D., Vice-Speaker 
13 S. 2nd St., Geneva 60134 

TRUSTEES 

1st District: 1977, Joseph L. Bordenave, M.D. 

1665 South Street, Geneva 60134 
2nd District: 1977, Allan L. Goslin, M.D. 
712 N. Bloomington, Streator 61364 
3rd District: 1976, David S. Fox, M.D. 
20829 Greenwood Center Ct., Olympia Fields 60461 
3rd District: 1976, Robert T. Fox, M.D. 
2136 Robin Crest, Glenview 60025 
3rd District: 1975, Eugene T. Hoban, M.D. 

6429 North Ave., Oak Park 60302 
3rd District: 1975, Joseph Skom, M.D. 
707 Fairbanks Ct., Chicago 60611 
3rd District: 1977, William M. Lees, M.D. 
6518 North Nokomis, Lincolnwood 60646 
3rd District: 1977, George Shropshear, M.D. 

1525 E. 53rd St., Chicago 60615 
3rd District: 1977, Philip G. Thomsen, M.D. 

13826 Lincoln Ave., Dolton 60419 
3rd District: 1976, Frederick E. Weiss, M.D. 

15643 Lincoln, Harvey 60426 
3rd District: 1975, Warren Young, M.D. 

3450 Haweswood Dr., Crete 60417 
4th District: 1976, Fred Z. White, M.D. 
723 N. 2nd St., Chillicothe 61523 
5th District: 1976, A. Edward Livingston, M.D. 

326 Fairway Dr., Bloomington 61701 
6th District: 1975, Mather Pfeiffenberger, M.D. 

State and Wall Sts., Alton 62002 
7th District: 1976, Arthur F. Goodyear, M.D. 

142 E. Prairie, Decatur 62523 
8th District: 1976, Eugene P. Johnson, M.D. 

P.O. Box 68, Casey 62420 
9th District: 1975, Warren D. Tuttle, M.D. 

203 N. Vine St., Harrisburg 62946 
10th District: 1975, Herbert Dexheimer, M.D. 

301 S. Illinois, Belleville 62220 
11th District: 1977, Ross Hutchison, M.D. 
126 E. Ninth St., Gibson City 60936 
Trustee-At-Large: Willard C. Scrivner, M.D. 

6600 West Main, Belleville 62223 
Chairman of the Board: Joseph L. Bordenave, M.D. 

1665 South Street, Geneva 60134 


Microfilm copies of current 
as well as some back issues 
of the Illinois Medical Jour- 
nal may be purchased from 
Xerox University Microfilm, 
300 North Zeeb Road, Ann 
Arbor, Mich. 48106. 



Contents of IMJ are listed in the Current Contents/ Clinical Practice. 

Published by the Illinois State Medical Society, 360 N. Michigan Ave., Chicago, 111. 60601 (312-782-1654) 
Copyright, 1974. The Illinois State Medical Society. 

Subscription $8.00 per year, in advance, postage prepaid, for the United States, Cuba, Puerto Rico, 
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Second class postage paid at Chicago, 111. When moving please notify Journal office of new address 
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Pharmaceutical advertising must be approved by the ISMS Publications Committee. Other advertising 
accepted after review by Publications Committee or Board of Trustees. All copy or plates must reach the 
Journal office by the fifteenth of the month preceding publication. Rates furnished upon request. 

Original articles will be considered for publication with the understanding that they are contributed only 
to the Illinois Medical Journal. The ISMS denies responsibility for opinions and statements expressed by 
authors or in excerpts, other than editorial or allied views or statements which reflect the authoritative action 
of the ISMS or of reports on official actions, policies or positions. Views expressed by authors do not 
necessarily represent those of the Society; any connection with official policies is coincidental. 



IMPORTANT INFORMATION: This is a Sched- 
ule V substance by Federal law: diphenoxylate 
HCI is chemically related to meperidine. In 
case ol overdosage or individual hypersensitiv- 
ity, reactions similar to those alter meperidine 
or morphine overdosage may occur ; treatment 
is similar to that for meperidine or morphine 
intoxication (prolonged and careful monitor- 
ing). Respiratory depression may recur in spite 
of an initial response to Nalline® (nalorphine 
HCI) or may be evidenced as late as 30 hours 
after ingestion. LOMOTIL IS NOT AN INNOC- 
UOUS DRUG AND DOSAGE RECOMMENDA- 
TIONS SHOULD BE STRICTLY ADHERED TO, 
ESPECIALLY IN CHILDREN. THIS MEDICA- 
TION SHOULD BE KEPT OUT OF REACH OF 
CHILDREN. 


HCI may potentiate the action of barbiturates, (han- 
quilizers and alcohol. In theory, the concurrent use 
with monoamine oxidase inhibitors could precipitate 
hypertensive crisis. 

Usage in pregnancy: Weigh the potential benefits 
against possible risks before using during preg- ■ 
nancy, lactation or in women of childbearing age. 
Diphenoxylate HCI and atropine are secreted in the 
breast milk of nursing mothers. 


Precautions: Addiction (dependency) to diphenoxy- 
late HCI is theoretically possible at high dosage. Do 
not exceed recommended dosages. Administer with 
caution to patients receiving addicting drugs or 
known to be addiction prone or having a history of 
drug abuse. The subtherapeutic amount of atropine is 
added to discourage deliberate overdosage; strictly 
observe contraindications, warnings and precautions 
for atropine; use with caution in children since signs 
of atropinism may occur even with the recommended 
dosage. 


Indications: Lomotil is effective as adjunctive ther- 
apy in the management of diarrhea. 


Contraindications: In children less than 2 years, due 
to the decreased safety margin in younger age 
groups, and in patients who are jaundiced or hyper- 
sensitive to diphenoxylate HCI or atropine. 

Warnings: Use with caution in young children, be- 
cause of variable response, and with extreme cau- 
tion in patients with cirrhosis and other advanced 
hepatic disease or abnormal liver function tests, 
because of possible hepatic coma. Diphenoxylate 


ages 2 to 5 years, 4 ml. (2 mg.) t.i.d.; 5 to 8 years, 4 
ml. (2 mg.) q.i.d.; 8 to 12 years, 4 ml. (2 mg.) 5 
times daily; adults, two tablets (5 mg.) t.i.d. to two 
tablets (5 mg.) q.i.d. or two regular teaspoonfuls 
(10 ml., 5 mg.) q.i.d. Maintenance dosage may be as 
low as one fourth of the initial dosage. Make down- 
ward dosage adjustment as soon as initial symptoms 
are controlled. 


Overdosage: Keep the medication out of the reach 
of children since accidental overdosage may cause 
severe, even fatal, respiratory depression. Signs of 
overdosage include flushing, lethargy or coma, hy- 
potonic reflexes, nystagmus, pinpoint pupils, tachy- 
cardia and respiratory depression which may occur 
12 to 30 hours after overdose. Evacuate stomach by 
lavage, establish a patent airway and, when neces- 
sary, assist respiration mechanically. Use a narcotic 
antagonist in severe respiratory depression. Obser- 
vation should extend over at least 48 hours. 


Adverse reactions: Atropine effects include dryness 
of skin and mucous membranes, flushing and urinary 
retention. Other side effects with Lomotil include 
nausea, sedation, vomiting, swelling of the gums, 
abdominal discomfort, respiratory depression, numb- 
ness of the extremities, headache, dizziness, depres- 
sion, malaise, drowsiness, coma, lethargy, anorexia, 
restlessness, euphoria, pruritus, angioneurotic 
edema, giant urticaria and paralytic ileus. 

Dosage and administration: Lomotil is contraindi- 
cated in children less than 2 years old. Use only 
Lomotil liquid for children 2 to 12 years old. For 


Dosage forms: Tablets, 2.5 mg. of diphenoxylate 
HCI with 0.025 mg. of atropine sulfate. Liquid, 2.5 
mg. of diphenoxylate HCI and 0.025 mg! of atropine 
sulfate per 5 ml. A plastic dropper calibrated in in- 
crements of Vi ml. (total capacity, 2 ml.) accom- 
panies each 2-oz. bottle of Lomotil liquid. 


cc adi c | Searle & Co. 

I San Juarli p uert0 Rico 00936 


Address medical inquiries to: 
G. D. Searle & Co. 

Medical Department, Box 5110, 
Chicago, Illinois 60680 


45 




Editorials 



Peptic Ulcer: Diet or Drugs? 


A quiet revolution has been going on among 
physicians who treat various gastrointestinal dis- 
eases. Many of our traditional concepts based on 
the need for dietary treatment of peptic ulcer 
disease have not held up when examined metic- 
ulously under controlled scientific conditions. 

Much of the controversy has to do with the 
fact that some foods are, by reputation, irritating, 
and others, soothing to the gastrointestinal tract. 
It is wrong to assume that the form, color, 
consistency, taste, or aroma of a certain food 
cotdd have any effect on gastrointestinal secre- 
tions, motility, or th<f mucosal lining. Yet, no one 
is willing to say that' a specific food is chemically 
and mechanically helpful, or detrimental. 

Milk, for example, stimulates acid production, 
but milk also has a buffering effect. Perhaps milk 
neutralizes the acid it produces in the stomach. 

According to a recent report, corn flakes and 
butter are probably ideal because they stimulate 
very little acid. Yet, each has considerable ability 
to neutralize acidity. 

Some physicians feel that antacids and anti- 
cholinergic drugs are better than a diet in the 
treatment of ulcer. I overheard a gastroenterolo- 
gist say that he tells his patients to eat what they 
want, but not to smoke cigarets or drink alcohol 
or coflee. He relies on antacids, but tells his pa- 
tients to avoid foods that they tolerate poorly. 
This man believes, however, that his patients 
should enjoy their food. 

Revolutionary changes also have been going on 
in the management of irritable bowel and diver- 


ticular disease. 

Today, the high-residue diet, rather than the 
lime-honored low-residue diet, is being advocat- 
ed. lire rationale is that diets high in vege- 
tables, fruits, and meat fiber pass more rapidly 
through the intestine, and do so with less diffi- 
culty. With greater stool weights, constipation is 
less likely to occur and the digesting food has 
less time for bacterial and enzymatic production. 

Soft, carbohydrate bulk-less foods tend to ling- 
er in t lie bowel and promote constipation. This, 
in (urn, leads to strong muscular contractions 
and increased internal pressure. Roughage en- 
courages a swiftly-passed stool, which subjects 
the colon to less strain anti does not favor diver- 
ticular development. The pockets seldom make 
a fuss unless their openings are blocked or they 
become inflamed. Antispasmodic drugs ease the 
cramping; antibiotics or sulfonamides control 
the infection. 

In contrast, diet is important in patients with 
celiac sprue. They do best on a gluten-free diet. 
A lactose-free diet helps those suffering from 
congenital malabsorption of lactose. Substitution 
of fructose for all sources of glucose and galactose 
can be life-saving for infants lacking the in- 
testinal mechanism for monosaccharides trans- 
port. 

Individuals who have idiosyncrasies to certain 
foods should avoid eating whatever does not 
agree with them. 

T. R. Van Dellen, M.D. 

Editor 


242 


Illinois Medical Journal 


The overweight 
diabetic... 

trapped by her 
own fat cells. 

If only she would diet, her blood 
sugar might come down. Her high 
levels of blood insulin might come 
down, too. This may be important 
in the overweight diabetic since 
insulin is the “storage hormone’’ 
that transports g I ucose i nto ad i pose 
tissue. Maybe the last thing the 
overweight diabetic needs to lower 
her blood sugar is a drug that stim- 
ulates more insulin secretion. 

If dieting doesn't work in the over- 
weight, nonketotic, adult-onset 
diabetic, consider adding DBI-TD. 

DBI-TD Geigy 

phenformin HCI 

Lowers blood sugar without 
raising blood insulin. 


DBI®phenformin HCI Tablets of 25 mg. 
DBI-TD^ phenformin HCI 

Timed-Disintegration Capsules of 50 and 100 mg. 


Indications : stable adult diabetes mel I it us; sulfonyl- 
urea failures, primary and secondary; adjunct to 
insulin therapy of unstable diabetes mellitus 
Contraindications : Diabetes mellitus that can be 
regulated by diet alone, juvenile diabetes mellitus 
that is uncomplicated and well regulated on in- 
sulin; acute complications of diabetes mellitus 
(metabolic acidosis, coma, infection, gangrene); 
during or immediately after surgery where insulin 
is indispensable; severe hepatic disease; renal dis- 
ease with uremia; cardiovascular collapse (shock); 
after disease states associated with hypoxemia. 
Warnin gs: Use during pregnancy is to be avoided. 
Precautions : 1 Starvation Ketosis: This must be 
differentiated from insulin lack ketosis and is 
characterized by ketonuria which, in spite of rel- 
atively normal blood and urine sugar, may result 


from excessive phenformin therapy, excessive in- 
sulin reduction, or insufficient carbohydrate intake. 
Adjust insulin dosage, lower phenformin dosage, 
or supply carbohydrates to alleviate this state. 

Do not give insulin without first checking blood 
and urine sugar. 

2. Lactic Acidosis: This drug is not recommended 
in the presence of azotemia or in any clinical situ- 
ation that predisposes to sustained hypotension 
that could lead to lactic acidosis. To differentiate 
lactic acidosis from ketoacidosis, periodic deter- 
minations of ketones in the blood and urine should 
be made in diabetics previously stabilized on phen- 
formin, or phenformin and insulin, who have be- 
come unstable. If electrolyte imbalance is sus- 
pected, periodic determinations should also be 
made of electrolytes, pH, and the lactate-pyruvate 
ratio. The drug should be withdrawn and insulin, 
when required, and other corrective measures 
instituted immediately upon the appearance of any 
metabolic acidosis. 

3. Hypoglycemia: Although hypoglycemic re- 


actions are rare when phenformin is used alone, 
every precaution should be observed during the 
dosage adjustment period particularly when insulin 
or a sulfonylurea has been given in combination 
with phenformin. 

Adverse Reactions : Principally gastrointestinal; 
unpleasant metallic taste, continuing to anorexia, 
nausea and, less frequently, vomiting and diarrhea. 
Reduce dosage at first sign of these symptoms. In 
case of vomiting, the drug should be immediately 
withdrawn. Although rare, urticaria has been re- 
ported, as have gastrointestinal symptoms such as 
anorexia, nausea and vomiting following excessive 
alcohol intake. (B) 98-146-103-E (6/72) 

For complete details , includin g dosage , please 
see full prescribin g information . 


GEIGY Pharmaceuticals 

Division of CIBA-GEIGY Corporation 

Ardsley, New York 10502 



DBM0225 


Clinics for Crippled Children 
Listed for November 

Twenty-nine clinics for Illinois’ physically handicapped 
children have been scheduled for November by the Uni- 
versity of Illinois, Division of Services for Crippled Chil- 
dren. The Division will conduct 22 general clinics provid- 
ing diagnostic orthopedic, pediatric, speech and hearing 
examination along with medical social and nursing ser- 
vices. There will be six special clinics for children with 
cardiac conditions, and one for children with cerebral 
palsy. Any private physician may refer to or bring to a 
convenient clinic any child or children for whom he may 
want examination or consultative services. 

Nov. 4 Peoria Cardiac— St. Francis Children’s Hospital 
Nov. 5 Belleville— St. Elizabeth’s Hospital 
Nov. 6 Hinsdale— Hinsdale Sanitarium 
Nov. 7 Sterling— Sterling Community Hospital 
Nov. 7 Effingham— St. Anthony Memorial Hospital 
Nov. 7 Lake County Cardiac— Victory Memorial Hospital 
Nov. 7 Springfield— St. John's Hospital 
Nov. 8 Chicago Heights Cardiac— St. James Hospital 
Nov. 12 Peoria— St. Francis Children’s Hospital 
Nov. 12 East St. Louis— Christian Welfare Hospital 
Nov. 12 Rock Island— Moline Public Hospital 
Nov. 13 Champaign-Urbana— McKinley Hospital 
Nov. 13 Joliet— St. Joseph's Hospital 
Nov. 14 Pittsfield— Illini Hospital 
Nov. 14 W. Frankfort— Union Hospital 
Nov. 14 Macomb— McDonough District Hospital 
Nov. 19 Decatur— Decatur Memorial Hospital 
Nov. 19 Fairfield— Fairfield Memorial Hospital 
Nov. 20 Rockford— St. Anthony Hospital 
Nov. 20 Centralia— St. Mary’s Hospital 
Nov. 20 Springfield Pediatric-Neurology— Diocesan Center 
Nov. 20 Evergreen Park— Little Company of Mary Hos- 
pital 

Nov. 21 Elmhurst Cardiac— Memorial Hospital of DuPage 
County 

Nov. 22 Chicago Heights Cardiac— St. James Hospital 

Nov. 25 Peoria Cardiac— St. Francis Children's Hospital 

Nov. 26 Peoria— St. Francis Children’s Hospital 

Nov. 26 Alton— Alton Memorial Hospital 

Nov. 27 Elgin— Sherman Hospital 

Nov. 27 Chicago Heights— St. James Hospital 

The Division of Services for Crippled Children is the 
official state agency established to provide medical, sur- 
gical, corrective and other services and facilities for diag- 
nosis, hospitalization and after-care for children with 
crippling conditions or who are suffering from conditions 
that may lead to crippling. 

In carrying on its program, the Division works coopera- 
tively with local medical societies, hospitals, the Illinois 
Children’s Hospital-School, civic and fraternal clubs, 
visiting nurse association, local social and welfare agencies, 
local chapters of the National Foundation and other in- 
terested groups. In all cases the work of the Division is 
intended to extend and supplement, not supplant activi- 
ties of other agencies, either public or private, state or 
local, carried on in behalf of crippled children. ◄ 


PROLOID® (thyroglobulin) 

Caution: Federal law prohibits dispensing without 
prescription. 

Description. Proloid (thyroglobulin) is obtained 
from a purified extract of frozen hog thyroid. 
It contains the known calorigenically active 
components, Sodium Levothyroxine (T4) and 
Sodium Liothyronine (To) . Proloid (thyroglobu- 
lin) conforms to the primary USP specifications 
for desiccated thyroid— for iodine based on 
chemical assay— and is also biologically as- 
sayed and standardized in animals. 

Chromatographic analysis to standardize the 
Sodium Levothyroxine and Sodium Liothyro- 
nine content of Proloid (thyroglobulin) is rou- 
tinely employed. 

The ratio of T 4 and T 3 in Proloid (thyroglob- 
ulin is approximately 2.5 to 1 . 

Proloid (thyroglobulin) is stable when stored 
at usual room temperature. 

Indications. Proloid (thyroglobulin) is thyroid 
replacement therapy for conditions of inade- 
quate endogenous thyroid production: e.g., 
cretinism and myxedema. Replacement therapy 
will be effective only in manifestations of hypo- 
thyroidism. 

In simple (nontoxic) goiter, Proloid (thyro- 
globulin) may be tried therapeutically, in non- 
emergency situations, in an attempt to reduce 
the size of such goiters. 

Contraindication. Thyroid preparations are 
contraindicated in the presence of uncorrected 
adrenal insufficiency. 

Warnings. Thyroglobulin should not be used 
in the presence of cardiovascular disease un- 
less thyroid-replacement therapy is clearly in- 
dicated If the latter exists, low doses should 
be instituted beginning at 0.5 to 1.0 grain (32 
to 64 mg) and increased by the same amount 
in increments at two-week intervals. This de- 
mands careful clinical judgment. 

Morphologic hypogonadism and nephroses 
should be ruled out before the drug is admin- 
istered. If hypopituitarism is present, the adre- 
nal deficiency must be corrected prior to 
starting the drug. 

Myxedematous patients are very sensitive to 
thyroid and dosage should be started at a very 
low level and increased gradually. 

Precaution. As with all thyroid preparations 
this drug, will alter results of thyroid function 
tests. 

Adverse Reactions. Overdosage or too rapid 
increase in dosage may result in signs and 
symptoms of hyperthyroidism, such as men- 
strual irregularities, nervousness, cardiac ar- 
rhythmias, and angina pectoris. 

Dosage and Administration. Optimal dosage 
is usually determined by the patient’s clinical 
response. Confirmatory tests include BMR, T3 
l3l l resin sponge uptake, T 3 l3, l red cell up- 
take, Thyro Binding Index (TBI), and Achilles 
Tendon Reflex Test. Clinical experience has 
shown that a normal PBI (3.5-8 mcg/100 ml) 
will be obtained in patients made clinically 
euthyroid when the content of T 4 and T 3 is 
adequate. Dosage should be started in small 
amounts and increased gradually with incre- 
ments at intervals of one to two weeks. Usual 
maintenance dose is 0.5 to 3.0 grains (32 to 
190 mg) daily. 

Overdosage Symptoms. Headache, instability, 
nervousness, sweating, tachycardia, with un- 
usual bowel motility. Angina pectoris or con- 
gestive heart failure may be induced or 
aggravated. Shock may develop. Massive over- 
dosage may result in symptoms resembling 
thyroid storm. Chronic excessive dosage will 
produce the signs and symptoms of hyperthy- 
roidism. 

(Treatment: In shock, supportive measures 
should be utilized. Treatment of unrecognized 
adrenal insufficiency should be considered.) 
How Supplied. 'A grain; V 2 grain; scored 1 
grain; 1 ’A grain; scored 2 grain; 3 grain; and 
scored 5 grain tablets, in bottles of 100 and 
1000 . 

Full information available on request. 



WARNER/CHILCOTT 

Division, Warner-Lambert Company 
Morris Plains, New Jersey 07950 


254 


PR-GP-31-B/1 


REFERENCE 

ISSUE 



ISMS ORGANIZATION 


History of Founding and Expansion 


Twenty-nine physicians met in Springfield 
June 4, 1850, to organize on a permanent basis 
the Illinois State Medical Society, which had been 
started informally 10 years earlier. The founders 
were concerned with the solution of ethical, scien- 
tific, legislative and economic problems. The first 
Constitution and Bylaws and the first Code of 
Medical Ethics were adopted; the first legislative 
committee was appointed, and a resolution out- 
lining the beginnings of interprofessional relations 
was approved. 

The Legislative Committee was instructed to 
“memorialize the legislature at its next session, 
praying the enactment of a statute providing for 
the registration of Births, Deaths and Marriages.” 
The resolution ruled that “members of the Society 
will discourage the sale of patent or secret nos- 
trums on the part of Druggists and Apothecaries 
throughout the State, and will patronize insofar 
as practicable, only those who abstain from the 
sale of such patent or secret nostrums.” 

The first full time secretary of the Society was 
Dr. Harold M. Camp who served for over 35 
years until his death in 1958. The first executive 
administrator, Robert L. Richards, was employed 
at the time the office was moved to Chicago in 
1960 and served until February, 1966. After an 
interim service by Dr. George F. Lull, Mr. Roger 
N. White was selected as Executive Administrator 
in May, 1968. 

The Society published the early transactions in 


book form presenting not only the minutes of the 
House of Delegates, but also all scientific papers 
given at each annual convention. In 1899 a new 
era of communications began, for at that time, 
the Illinois Medical Journal was established and 
became the first “official organ of the Society.” 

Dr. G. N. Kreider was its first editor and served 
until 1913, followed by Dr. Clyde D. Pence with 
Dr. Henry G. Olds as the first managing editor. 
Dr. Charles G. Whalen became editor in 1919 and 
he and Dr. Olcls served until they died in 1940. 
Dr. Camp followed Dr. Whalen, and Dr. Theodore 
R. Van Dellen is the editor today. 

Dr. Whalen spearheaded many important activi- 
ties in medicine, and has been called “the oustand- 
ing champion of the medical profession in its 
economic contacts.” He has been credited as one 
of the first medical editors to blast “the socializa- 
tion of medicine in this country.” In 1922 he wrote 
extensively on state medicine, workmen’s compen- 
sation, compulsory health insurance, free hospital- 
ization and federal aid. 

The first Fifty Year Club in the United States 
was announced by the Illinois Medical Journal in 
1938. 

The fourth largest medical society in the coun- 
try has developed from these embryonic begin- 
nings. This edition of the Illinois Medical Journal 
offers you an opportunity to contrast the extensive 
services available to the membership today with 
those offered in the past. 


268 


Illinois Medical Journal 


OFFICERS AND PLACES OF MEETING 


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for October, 1974 


269 


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270 


Illinois Medical Journal 


Principles Of Medical Ethics 


Preamble: These principles are intended to aid 
physicians individually and collectively in main- 
taining a high level of ethical conduct. They are 
not laws but standards by which a physician 
may determine the propriety of his conduct in 
his relationship with patients, with colleagues, 
with members of allied professions, and with the 
public. 

Section 1 — The principal objective of the medi- 
cal profession is to render service to humanity 
with full respect for the dignity of man. Physicians 
should merit the confidence of patients entrusted 
to their care, rendering to each a full measure of 
service and devotion. 

Section 2 — Physicians should strive continually 
to improve medical knowledge and skill, and 
should make available to their patients and col- 
leagues the benefits of their professional attain- 
ments. 

Section 3 — A physician should practice a method 
of healing founded on a scientific basis; and he 
should not voluntarily associate professionally with 
anyone who violates this principle. 

Section 4 — The medical profession should safe- 
guard the public and itself against physicians 
deficient in moral character or professional compe- 
tence. Physicians should observe all laws, uphold 
the dignity and honor of the profession and 
accept its self-imposed disciplines. They should 
expose, without hesitation, illegal or unethical con- 
duct of fellow members of the profession. 

Section 5 — A physician may choose whom he 
will serve. In an emergency, however, he should 
render service to the best of his ability. Having 
undertaken the care of a patient, he may not 
neglect him; and unless he has been discharged he 
may discontinue his services only after giving 


adequate notice. He should not solicit patients. 

Section 6 — A physician should not dispose of his 
services under terms or conditions which tend to 
interfere with or impair the free and complete 
exercise of his medical judgment and skill or tend 
to cause a deterioration of the quality of medical 
care. 

Section 7 — In the practice of medicine a physician 
should limit the source of his professional income 
to medical services actually rendered by him, or 
under his supervision, to his patients. His fee 
should be commensurate with the services rendered 
and the patient’s ability to pay. He should neither 
pay nor receive a commission for referral of pa- 
tients. Drugs, remedies or appliances may be 
dispensed or supplied by the physician provided 
it is in the best interests of the patient. 

Section 8 — A physician should seek consultation 
upon request, in doubtful or difficult cases; or 
whenever it appears that the quality of medical 
service may be enhanced thereby. 

Section 9 — A physician may not reveal the 
confidences entrusted to him in the course of 
medical attendance, or the deficiencies he may 
observe in the character of patients, unless he 
is required to do so by law or unless it becomes 
necessary in order to protect the welfare of the 
individual or of the community. 

Section 10 — The honored ideals of the medical 
profession imply that the responsibilities of the 
physician extend not only to the individual, but 
also to society where these responsibilities deserve 
his interest and participation in activities which 
have the purpose of improving both the health 
and the well-being of the individual and the 
community. 


for October , 1974 


271 


Constitution And Bylaws 


Adopted, 1903 
As Amended, 1974 


CONSTITUTION 


ARTICLE I. NAME 

The name and title of this organization shall be the 
Illinois State Medical Society. 

ARTICLE II. PURPOSES OF THE SOCIETY 
The purposes of this Society are to promote the science 
and art of medicine, to protect the public health, to 
elevate the standards of medical education and to unite 
the medical profession behind these purposes; to pro- 
mote similar interests in the component societies and to 
unite with similar organizations in other states and terri- 
tories of the United States to form the American Medical 
Association. The Society shall inform the public and the 
profession concerning the advancements in medical science 
and the advantages of proper medical care. 

ARTICLE III. COMPONENT SOCIETIES 
Component societies shall consist of those county medical 
societies which hold charters from this Society. 

ARTICLE IV. COMPOSITION OF THE SOCIETY 
The Society shall consist of active members and such 
other members as the Bylaws may provide. 

ARTICLE V. HOUSE OF DELEGATES 
Section 1. The House of Delegates shall be the legislative 
body of the Illinois State Medical Society, and unless 
otherwise herein provided, its deliberations shall be bind- 
ing upon the officers, including the Board of Trustees. 
The House of Delegates shall set the basic policy and 
philosophy of the Society. 

Section 2. The House of Delegates shall elect the general 
officers, except as otherwise provided in the Bylaws. 


ARTICLE VI. OFFICERS 

The officers of this Society shall be a president, a presi- 
dent-elect, a first vice president, a second vice president, 
a secretary-treasurer, a speaker and vice speaker of the 
House of Delegates, nineteen trustees and one trustee 
at large, and such other officers as the Bylaws may provide. 

ARTICLE VII. BOARD OF TRUSTEES 
The Board of Trustees, whose duties are executive and 
judicial, shall have charge of all property and all finan- 
cial affairs of the Society, and shall perform such other 
duties as are prescribed by law governing the directors 
of corporations, or as may be prescribed in the Bylaws. 

ARTICLE VIII. CONVENTIONS AND MEETINGS 
The Society shall hold an annual convention during which 
there shall be a business meeting of the House of Dele- 
gates and general scientific meetings which shall be open 
to all registered members. 

ARTICLE IX. THE SEAL 

This Society shall have a common seal with power to 
break, change or renew the same when necessary. 

ARTICLE X. AMENDMENTS 
The House of Delegates may amend this Constitution at 
any annual business meeting of the House of Delegates 
provided that the amendment shall have been proposed 
at the preceding annual business meeting, and that two- 
thirds of the members of the House of Delegates seated 
concur in the amendment. 


BYLAWS 


CHAPTER I. MEMBERSHIP 
Section 1. Members. Members shall consist of Regular 
members. Provisional members, Associate members, 
Emeritus members, Retired members, Service members, 
Distinguished members, In-training members and Student 
members. Members enjoy full rights and privileges, in- 
cluding the right to vote and hold office and are counted 
in determining the strength of the Society’s Delegation 
to the American Medical Association. 

A. Regular Members. Regular members shall be those 
physicians licensed to practice medicine in all its 
branches in the State of Illinois, who are residents 
of the State of Illinois, persons of good moral char- 
acter and professional standing and members of their 
component society. 


Members in good standing moving out of Illinois may 
retain membership (not to exceed one year) in the 
Illinois State Medical Society until they are accepted 
into membership in the medical society of the state to 
which they have moved. 

Physicians serving as full-time employees of the Ameri- 
can Medical Association and other physicians licensed 
in one of the states or territories of the United States 
but not licensed in Illinois may become regular mem- 
bers although they are not actively engaged in the 
practice of medicine. 

B. Provisional Members. Provisional membership shall be 
available to any Illinois physician who has made a 
declaration of intention to become a citizen of the 
United States, who has received a license in this 


272 


Illinois Medical Journal 


State to practice medicine in all of its branches, and 
who— with the exception of United States citizenship— 
possesses all of the qualifications for membership pre- 
scribed by these Bylaws. Provisional membership shall 
terminate one year after the expiration of the mini- 
mum period of time within which such member 
could have perfected his citizenship. After obtaining 
full citizenship and prior to the expiration of his 
provisional membership, such member may be, upon 
application to his component medical society, trans- 
ferred to regular membership. 

C. Associate Members. Associate members are physicians 
who hold the degree of Doctor of Medicine, who 
have a hospital permit to practice medicine in the 
State of Illinois and are members of their component 
medical society. 

D. Emeritus Members. Emeritus members are those who 
have been regular members in good standing for 
thirty-five years, have reached or will have reached 
the age of seventy before the next fiscal year of the 
Society, have made written application to their com- 
ponent society and have been recommended by their 
component society for emeritus status. Such member- 
ship shall be effective January first of the year follow- 
ing election. Credit for membership in other Ameri- 
can Medical Association constituent societies shall be 
accorded transferees, provided they have been mem- 
bers of this Society for at least five years. 

E. Retired Members. Retired members shall consist of 
those who have been regular members and who by 
reason of age or incapacity have retired from active 
practice and who upon application and recommenda- 
tion from their component society have been made 
retired members. Retired status is not available to 
physicians who assume compensated positions after re- 
tiring from medical practice. 

F. Service Members. Physicians serving as medical officers 
in the United States Governmental Services, who are 
members of a component society, so long as they 
are engaged actively fulltime in their respective serv- 
ice, and thereafter if they have been retired on ac- 
count of age or physical disability, shall be elected to 
service membership. 

G. Distinguished Members. Physicians of Illinois or other 
states or foreign countries who have risen to promi- 
nence in the profession, teachers of medicine or of 
the sciences allied to medicine, not eligible for regu- 
lar membership, or members of associated arts and 
sciences, who have made significant contributions to 
medicine may be nominated by any member of the 
House of Delegates and may be elected by the House 
at any annual convention by a two-thirds affirmative 
vote of those present and voting. They shall not be 
considered as members in determining the number 
of delegates to the American Medical Association, but 
they may participate in all other society activities. 

H . In-Training Members. In-training members are per- 
sons who are medical school graduates, of good moral 
character and professional standing and serving an 
internship or residency approved by the American 
Medical Association in the State of Illinois and are 
members, of a component medical society. Membership 
shall end at the end of the year in which training is 
terminated. Following this, in-training members may 
apply for regular membership through their com- 
ponent society. 


I. Student Members. Student members are those who 
have been accepted for the second year or higher 
in an Illinois medical school, are of good moral 
character, professional and academic standing and stu- 
dent members of a component medical society. 

Section 2. Discrimination of Membership. Membership 
in the Illinois State Medical Society shall not be denied 
or abridged because of color, creed, race, religion or 
ethnic origin. 

Section 3. Tenure and Termination. 

A. Tenure of Membership. The name of a physician on 
a properly certified roster of members of a compon- 
ent society which has paid its annual assessments, 
shall be prima facie evidence of membership in this 
society. The member shall retain his membership so 
long as he complies with the provisions of this Con- 
stitution and Bylaws and with the Principles of 
Medical Ethics of the American Medical Association. 
A member shall hold only one type of membership 
at any one time. 

B. Termination of Membership. Any person who is under 
sentence of suspension, or expulsion from a component 
society shall not be entitled to any of the rights or 
benefits of this society nor shall he be permitted to 
take part in any of the proceedings until he has been 
reinstated. Non-payment of dues by May 1 of each 
year shall be grounds for termination of membership. 

CHAPTER II. DUES, FUNDS AND ASSESSMENTS 

Section 1. Dues. Annual dues may be levied by the 
House of Delegates on each class of membership. The 
amount of dues shall be recommended by the Board 
of Trustees and shall be fixed by the House of Delegates 
and shall include the dues and/or assessments approved 
by the House of Delegates of the American Medical 
Association. These shall include the annual subscription 
to the Illinois Medical Journal which shall be at least 
fifty percent of the regular subscription price of the 
Journal. Only Regular, Provisional, Associate, In-train- 
ing and Student members shall be assessed annual dues. 
The assessment shall be paid by the component society 
for its members prior to March 31 of each year. 

Section 2. Reduction and Remission of Dues. Physi- 
cians in private practice of medicine may be given a 
fifty percent reduction in dues during the first year of 
practice, upon recommendation of their component so- 
ciety. Physicians approved for membership after June 30 
shall pay one-half the annual dues for that year. The 
Board of Trustees may authorize remission of dues of 
any member on recommendation of his component society 
for good reason. In such cases the secretary shall recom- 
mend remission of dues by the American Medical Associa- 
tion. Emeritus members, Retired members. Service mem- 
bers and Distinguished members are not required to 
pay dues. 

Section 3. Assessments and Funds. In addition to dues, 
assessments may be made on dues-paying members on 
recommendation of the Board of Trustees and approval 
of the House of Delegates. Funds may be raised from 
publications of the Society and any other manner ap- 
proved by the Board of Trustees. Funds may be appro- 
priated by the Board of Trustees to be spent for the 
Society to carry on its publications, to encourage scientific 
investigations, and for other purposes approved by the 
Board of Trustees. 


for October , 1974 


273 


CHAPTER III. 

EDUCATIONAL AND SCIENTIFIC PROGRAMS 

Educational and scientific programs shall be provided by 
the Society at such times and places as recommended by 
the Board of Trustees and approved by the House of 
Delegates. 

CHAPTER IV. HOUSE OF DELEGATES 

Section 1. Composition. The voting membership of the 
House of Delegates shall consist of 1) delegates elected 
by component societies and affiliated groups, 2) the 
President, 3) the President-elect, 4) the Vice Presidents, 
5) the Secretary-Treasurer, 6) the Speaker and Vice 
Speaker, and 7) Trustees. Past trustees, past presidents, 
past speakers, general officers of the American Medical 
Association, and delegates and alternate delegates from 
the Illinois State Medical Society to the American Medi- 
cal Association may have the privilege of the floor 
without vote. 

Section 2. Delegates. Each component society shall be 
entitled to send one of its members to the House of 
Delegates each year for each seventy-five members, not 
to include student members, and one for a major frac- 
tion thereof, but each component society which has made 
its annual report and paid its assessment as provided 
for in this Constitution and Bylaws shall be entitled 
to one delegate. The number of delegates to which any 
component society is entitled shall be determined by the 
number of members of the component society on mem- 
bership rolls of the Illinois State Medical Society as of 
December 31 of the preceding year. The term of office of 
a delegate shall begin January first following his elec- 
tion and shall be for two years, or until his successor 
has been elected. Component societies with only one 
delegate may elect for one year. 

Section 3. Affiliate Croup Delegates. The combined Illinois 
chapters of the Student American Medical Association 
shall be considered a single affiliate group and shall be 
entitled to one student delegate with vote, and one stu- 
dent alternate delegate to serve in the House of Delegates. 
One intern/resident delegate with vote and an alternate 
delegate, representing the interests of Illinois house staff, 
shall be nominated by the Advisory Committee to Physi- 
cians in Training pursuant to appointment by the Board 
of Trustees. Each delegate shall be considered as an 
Affiliated Group Member of the Illinois State Medical 
Society. The term of office shall begin January first follow- 
ing his election and shall be for two years, or until his 
successor is elected. 

Section 4. Time and Place of Meeting. The House of 
Delegates shall meet annually at such time and place 
as it shall determine. 

Section 5. Quorum. Fifty delegates representing no less 
than twenty component societies shall constitute a quorum 
for the transaction of business. 

Section 6. Special meetings. Special meetings of the 
House of Delegates may be called by a majority of the 
Board of Trustees or upon petition of twenty compon- 
ent societies. When a special meeting is called, the sec- 
retary shall mail a notice to the last known address of 
each member of the House of Delegates at least ten days 
before the special meeting is to be held. The notice 
shall specify the time and place of the meeting and 
the purpose for which the meeting is called. The meeting 


shall not consider any business except that for which 
it was called. 

Section 7. Registration. Before being seated at any annual 
or special session, each delegate or his alternate shall 
deposit with the Reference Committee on Credentials a 
certificate signed by the President and/or the Secretary 
of his component society stating that the delegate or 
alternate has been regularly elected to the House of 
Delegates. A delegate or his alternate may be seated 
without credentials, provided he is properly identified 
and is certified to the secretary of the Illinois State 
Medical Society. Whenever a delegate or his alternate 
are unable to attend a particular meeting, the compon- 
ent society may select and certify a substitute delegate 
who shall have the same powers and duties as did the 
delegate. A delegate whose credentials have been accepted 
lay the Reference Committee on Credentials and whose 
name has been placed on the roll of the House, shall 
remain a delegate until the final adjournment of that 
session. If a delegate, once seated, is unable to be present 
for reasons acceptable to the Committee on Credentials, 
an alternate may be certified by the committee. After the 
alternate has been seated, he cannot be replaced for that 
session. 

Section 8. District Division. The House of Delegates shall 
divide the state into districts, specifying which counties 
each district shall include. 

Section 9. Order of Procedure. The order of business of 
the House of Delegates shall be determined by the 
Speaker, subject to approval by the Reference Commit- 
tee on Rides and Order of Business. Sturgis Standard 
Code of Parliamentary Procedure, Current Edition, shall 
be the guide for all procedure when not in conflict with 
the Constitution and Bylaws. 

Section 10. Privilege of the Floor. The House of Dele- 
gates by two-thirds vote of those present and voting, 
may extend an invitation to address the House to any 
person who in its judgment might assist in its delibera- 
tions. 

Section 11. Introduction of Resolutions and Other Busi- 
ness. All resolutions must be introduced by a voting mem- 
ber of the House. Resolutions to be printed in the 
handbook must be submitted nine weeks prior to the 
annual meeting. Resolutions to be mailed to the dele- 
gates prior to the annual meeting must be submitted 
to ISMS headquarters four weeks prior to the annual 
meeting. Resolutions submitted after the above date must 
be approved by the Speaker, Vice Speaker and one dele- 
gate from CMS and one from outside CMS or by a two- 
thirds vote of the House of Delegates before they will 
be considered as business of the House. Reports of com- 
mittees, councils and officers requiring action must submit 
recommendations to the House as a resolution for action. 
Reports, resolutions and requests for action after the 
opening of the first session of the House of Delegates 
shall require for consideration a two-thirds affirmative 
vote. 

CHAPTER V. ELECTION OF OFFICERS 

Section 1. Officers. The officers of this Society shall con- 
sist of the president, president-elect, first and second vice 
presidents, secretary-treasurer, speaker and vice speaker, 
nineteen trustees and one trustee-at-large. 

Section 2. Elections. All elections shall be by ballot except 
when there is only one candidate for a given office, then 
election may be by voice vote. 


274 


Illinois Medical Journal 


The majority of votes cast shall be necessary to elect. 

The election of officers, delegates and alternate dele- 
gates to the AMA, shall follow the completion of action 
on current and old business at the final session of the 
House of Delegates. 

Section 3. Terms of Office. The president-elect, vice- 
presidents secretary-treasurer, the speaker and vice speaker 
shall be elected annually by the House of Delegates to 
serve for a term of one year. 

Members of the Board of Trustees shall be elected 
by the House of Delegates to serve for a term of three 
years. 

The speaker and vice speaker shall not be elected for 
more than two consecutive terms to their respective 
offices; they shall be elected from the membership of 
the House of Delegates. 

The president-elect shall be inducted into the office 
of president by the retiring president during the final 
session of the House of Delegates. After assuming office 
at the adjournment of the annual business meeting, he 
shall continue in office until his successor has been elected 
and installed. Following his retirement as president, he 
shall automatically become a trustee-at-large for a term 
of one year. 

CHAPTER VI. DUTIES OF OFFICERS 

Section 1. The President. The president of the Illinois 
State Medical Society shall lead the Society in all its 
functions. He shall deliver an annual address at such 
time as may be arranged, and perform such other duties 
as custom and parliamentary usage may require. 

Section 2. The Vice Presidents. The vice presidents shall 
act for and perform such duties for the president as he 
shall direct. They shall, when so acting, implement and 
advance the programs and policies of the president. 

In the event of the president’s death, resignation or 
removal from office, the first vice president shall succeed 
to the presidency. 

In the event of a vacancy in the office of first vice 
president, the second vice president will become first vice 
president. 

Section 3. Successor to President-Elect. In the case of 
death, resignation, or removal from office of the presi- 
dent-elect, the office shall be filled by the House of 
Delegates at the next annual convention by election at 
a time recommended by the Reference Committee on 
Rides and Order of Business. 

Section 4. The Speaker. The speaker, who shall be versed 
in parliamentary procedure, shall preside at the meetings 
of the House of Delegates and shall perform such duties 
as custom and parliamentary usage require. 

He shall appoint all committees of the House of 
Delegates. 

He shall seek the advice of officers and trustees. 

He shall be an ex-officio member of the Committee 
on Constitution and Bylaws. 

Section 5. The Vice Speaker. The vice speaker shall pre- 
side for the speaker in the latter’s absence or at his re- 
quest. In case of death, or resignation of the speaker, the 
vice-speaker shall serve during the unexpired term. 

Section 6. The Secretary-Treasurer. In addition to the 
rights and duties ordinarily devolving on the secretary 


of a corporation by law, custom or parliamentary usage, 
and those granted or imposed in other provisions of the 
Constitution and these Bylaws, the secretary-treasurer 
shall be the official custodian of all securities and the 
income therefrom owned by the Society, subject to the 
direction and disposition of the Board of Trustees. He 
shall be a member of the Finance Committee of the 
Board of Trustees. 

The Board of Trustees may select a bank or trust 
company to act as custodian in the place of the secretary- 
treasurer, of all or any part of such securities and to act 
as agent of the Society in collecting the income therefrom. 

He shall perform such other duties as may be directed 
by the House of Delegates or by the Board of Trustees. 

In the event of a vacancy in the office of the secretary- 
treasurer, the Board of Trustees shall fill the vacancy 
until the next annual election. 


CHAPTER VII. THE BOARD OF TRUSTEES 

Section 1. Composition. The Board of Trustees shall con- 
sist of: nineteen trustees elected by the House of Delegates, 
one trustee-at-large (the retiring president, who shall 
serve a term of one year) , the president, the president- 
elect, the speaker and vice speaker of the House of Dele- 
gates, the first vice president and second vice president, 
and the secretary treasurer. Nine trustees shall be chosen 
from District 3 and one from each of the other ten districts 
as defined on the geographical map of the state approved 
in May, 1946. 

Section 2. Duties. The duties of the Board of Trustees are 
executive, custodial and judicial. 

A. Executive Duties. The Board of Trustees shall imple- 
ment all mandates from the House of Delegates except 
in matters of property or finance when it shall have 
sole authority. 

The Board of Trustees may establish a not-for-profit 
corporation of physicians known as the Illinois Foun 
elation for Medical Care. 

The Board of Trustees may request a report from 
any committee in the interim between meetings of 
the House of Delegates. 

B. Custodial Duties. The Board of Trustees shall have 
charge and control of all property of whatsoever na- 
ture belonging to the Society, and of all funds from 
whatsoever source belonging to the Society. 

No person shall expend or use for any purpose 
money belonging to the Society without the approval 
of the Board of Trustees. 

All money received by the Board of Trustees and 
its agents, resulting from the duties assigned them, 
shall be paid into the treasury of the Society, and all 
orders on the treasury for disbursement of money 
shall be approved by the Board. 

The Board of Trustees shall formulate rules govern- 
ing the expenditure of money to meet the necessary 
running expenses and fixed charges of the Society. 

All acts of the House of Delegates involving the 
expenditure, appropriation or use in any manner of 
money, or the acquisition or disposal in any manner 
of property of any kind belonging to the Society, must 
be approved by the Board of Trustees before same 
shall become effective. 

Funds may be appropriated to encourage scientific 
investigation, medical education or any other purpose 
deemed proper and approved by the Board of Trustees. 


for October, 1974 


275 


C. Judicial Duties. The Board of Trustees shall be the 
board of censors of the Society. It shall have jurisdic- 
tion over all questions of ethics and in the interpreta- 
tion of the laws of the Society. It shall consider all 
questions involving the rights and standing of mem- 
bers, whether in relation to other members, to com- 
ponent societies, or to this Society. 

All questions of an ethical nature before the House 
of Delegates or the general scientific meetings, shall 
be referred to the Board of Trustees without discus- 
sion. The Board shall hear and decide all questions 
of procedure affecting the conduct of members on 
which an appeal is taken from the decision of a com- 
ponent society. 

The decision of the Board of Trustees shall be final 
except that an appeal may be taken by a member 
charged with misconduct as provided for in the Con- 
stitution and Bylaws of the American Medical 
Association. 

Section 3. Executive Administrator. The Board of Trus- 
tees shall employ an executive administrator (who, when 
he shall be a physician, may be designated as the execu- 
tive vice-president) whose duties shall be determined by 
the Board. He shall be responsible to the chairman of 
the Board. The Board shall review at each of its meet- 
ings the interim activities of the administrator. The 
Board also shall employ such other people as are needed 
for the conduct of the affairs of the Society. 

Section 4. Meetings. The Board of Trustees shall meet 
daily during the annual convention of the Society, and 
at such other times as necessity may require, subject to 
the call of the chairman, or on the petition of the ma- 
jority of the Trustees. 

Section 5. Organization. 

A. Chairman. The Board of Trustees shall meet on the 
last day of the annual convention and elect from 
among its members a chairman. He shall hold office 
for one year and may succeed himself for one addi- 
tional year. 

B. Duties of the Chairman. The chairman of the Board 
of Trustees shall prepare an agenda and shall preside 
at all meetings of the Board. He shall make an an- 
nual report to the House of Delegates. He shall be 
chairman of the Executive Committee. He shall present 
the report of the actions of the Executive Committee 
to the Board. 

Section 6. Quorum. Ten members of the Board of Trustees 
from at least seven districts shall constitute a quorum 
for the transaction of business. 

Section 7. County Societies. The Board of Trustees shall 
have authority to organize the physicians of two or more 
counties into societies to be suitably designated, and these 
societies, when organized and chartered, shall be entitled 
to all rights and privileges provided for component socie- 
ties until such counties shall be organized separately. 

Section 8. Publication. The Board of Trustees shall pro- 
vide and superintend the publication and the distribution 
of all proceedings, transactions and memoirs of the So- 
ciety, and shall have authority to appoint an editor and 
such assistants as it deems necessary. 

Section 9. Bonding. The Board of Trustees shall provide 
at the expense of the Society, adequate bond for those 


officers and employees of the Society it considers require 
bonding. 

Section 10. Duties of Trustees. Each trustee shall be the 
organizer, consultant, advisor, administrator and speaker 
for the members of his district, and represent the Society 
as well as the members of his district at the Board 
meetings. 

Each trustee should visit the societies in his district 
at least once a year. He shall make an annual report of 
his work and the condition of the profession in each 
society in his district to the Board of Trustees and to 
the House of Delegates. 

Where his district is composed of more than one 
county, the trustee shall be an ex-officio members of all 
district committees. He shall report to the Board of Trus- 
tees the actions of the component societies on reports of 
these committees. 

The necessary traveling expenses incurred by such trus- 
tee in the line of the duties herein imposed, may be 
allowed by the Board of Trustees upon presentation of 
a properly itemized statement. 

Section 11. Vacancies. If during the interval between two 
annual conventions, sickness, death, or removal from 
the state or district, or any other reason prevents a trus- 
tee from attending the duties of his district, or if he shall 
be absent from two consecutive meetings of the Board, 
his office may be declared vacant at the discretion of the 
Board. The Board shall have the authority to fill the 
vacancy for the period between the date at which the 
office was declared vacant and the next annual meeting 
of the House of Delegates. 

Section 12. The Benevolence Fund. Each year the Board 
shall appropriate from the funds of this Society such 
sum or sums as it may deem proper to be held in a 
fund to be known as “The Benevolence Fund.” This 
fund is established and shall be used only for the assistance 
or relief of needy members of this Society, their widows, 
widowers, or minor children. The assets shall be held 
in the treasury of this Society in a separate fund. Dona- 
tions or bequests to the Benevolence Fund automatically 
become a part of these assets. 

Section 13. Audit and Financial Statement. The Board of 
Trustees shall employ annually a certified public account- 
ant to audit all accounts of the Society, and present a 
statement of same in its annual report to the House of 
Delegates. 

This report also shall specify the character and cost 
of all publications of the Society during the year, and 
the amount of all other property belonging to the 
Society under its control, with such suggestions as it 
may deem necessary. 

CHAPTER VIII. DISTRICT COMMITTEES 

Each trustee district which is composed of more than 
one county, shall have an Ethical Relations Committee, 
a Peer Review Committee, and such other committees 
as required to provide to each component society those 
services the component society mav not be able to provide 
for itself. District committees shall function only at the 
request of a component society within the district. 

Complaints initially received by district committees 
shall be referred immediately to the component society 
for action. 

District committees shall be governed by the procedural 


27G 


Illinois Medical Journal 


rules and regulations governing the counterpart state 
society committee or by these Bylaws. 

Reports of findings and recommendations of these 
district committees shall be made to the component 
society which requested action. 

The district trustee shall include a summary of the 
activities of each of these committees and the findings 
in general, in his annual report to the House of Delegates. 

The committee members shall be elected at a meeting 
of the delegates of the district called by the trustee of the 
district, before or during the annual convention of the 
Illinois State Medical Society. Chairmen of the commit- 
tees shall be designated by the trustee of the district, and 
the trustee shall be an ex-officio member of each com- 
mittee. 

CHAPTER IX. COMMITTEES 

Section 1. Committee Structure. The committee structure 
of the Illinois State Medical Society shall be as follows: 

A. Councils (standing committees) 

B. House of Delegates Committees 

C. Board of Trustees Committees 

D. Ethical Relations Committee (Chapter XI of these 
Bylaws) 

Section 2. Councils. 

A. The Medical-Legal Council shall be concerned in the 
areas of: 

1. Liaison with the Illinois Bar Association 

2. Liaison with courts, particularly where impartial 
medical testimony is involved. 

3. Implementation of the Impartial Medical Testimony 
Rule 

4. Legal aspects of medical practice other than in 
the area of mental health 

5. Licensing and standards of practice. 

6. Quackery 

7. Anatomical gifts and organ transplants 

B. The Council on Governmental Affairs shall be con- 
cerned in the areas of: 

1. Federal and state legislation— analysis and com- 
munication 

2. Legislative liaison— both state and federal 

3. Political education 

C. The Council on Education and Manpower shall be 
concerned in the areas of: 

1. Liaison with medical schools, curricula, etc. 

2. Health manpower and training 

3. Internships, residencies, etc. 

4. Scientific assembly 

5. Student loans 

6. Liaison with Student American Medical Association 

7. Continuing Medical Education 

D. The Council on Economics and Peer Review shall be 
concerned in the areas of: 

1. Relations with governmental purchase of care pro- 
grams (Medicare, Medicaid, Vocational Rehabili- 
tation, etc.) 


2. Relations with prepayment, insurance and other 
third party plans. 

3. Fees and fee adjudication 

4. Health care cost and utilization 

5. Peer Review (Part 2 of Chapter XII of these 
Bylaws) 

E. The Council on Environmental and Community Health 
shall be concerned in the areas of: 

1 . Governmental Departments of Health 

2. Public Safety 

3. Occupational Health 

4. Child and School Health 

5. Pollution 

6. Nutrition 

7. Maternal Welfare 

F. The Council on Public Relations and Membership 
Services shall be concerned in the areas of: 

1. Publicity and promotion 

2. News media relations 

3. Exhibits and public service programming 

4. Religion and medicine 

5. New member orientation and membership benefit 
explanation 

G. The Council on Mental Health and Addiction shall be 
concerned in the areas of: 

1. Facilities and services 

2. Liaison with Department of Mental Health 

3. Legal aspects of commitment, etc. 

4. Narcotics and dangerous drugs 

5. Alcoholism 

H. The Council on Social and Medical Services shall be 
concerned in the areas of: 

1. Health care facilities and services 

2. Emergency and disaster care 

3. Liaison with other health professional and health 
oriented organizations 

4. Health care of the poor 

5. Problems of aging 

6. Rural health 

I. The Council on Affiliate Societies shall be concerned in 
the areas of: 

1. Liaison between the affiliate society and ISMS. 

2. Scientific resource information and advice to ISMS. 

3. Consultation to other councils, e.g., postgraduate 
education, health care delivery, publicity, legislation. 

4. Advances of medical science in special fields. 

Section 3. Organization of Councils. 

A. Councils and the chairmen thereof shall be appointed 
by the Board of Trustees. 

B. Each Council shall have authority to request the 
Board of Trustees to appoint subcommittees under 
the councils for any purpose within the functions of 
the Council. A member of the Council shall be de- 
signated as chairman of each subcommittee and shall 
be selected by the Board of Trustees. Each subcommit- 
tee shall be used only for the specific purpose or pur- 


for October, 197-1 


277 


poses assigned to it and shall terminate as soon as 
its final report has been made or at the direction of 
the Board. The chairman of a Council may not serve 
as chairman of any subcommittee of the Council. 

C. Members of the Illinois State Medical Society (who 
are not voting members of the Board of Trustees) may 
be appointed to serve as chairmen or members of 
any council or committee. Students nominated by Illi- 
nois Chapters of the Student American Medical Asso- 
ciation, or other recognized student organizations 
approved by the Illinois State Medical Society Board 
of Trustees to serve with Illinois State Medical Society 
members on appropriate committees, may by action 
of the Board of Trustees, be accorded membership 
in this classification for the term of the committee 
appointment. Such members shall be permitted full 
privileges of committee membership, including (with 
the permission of the House of Delegates) the right to 
speak on the floor of the House, but to have no vote 
out of committee. Voting members of the Board of 
Trustees may serve as advisory members to any coun- 
cil or committee. 

Recommendations for membership on any commit- 
tee may be submitted to the Board of Trustees by 
the House of Delegates, or in writing by any mem- 
ber of the Society. 

A state committee which reviews the decisions of a 
similar committee of a component society may not have 
as a member one who currently serves on the same 
committee of a component society or district. 

D. Each Council shall submit for adoption a budget for 
the ensuing year which shall include any subcom- 
mittees, and the Board of Trustees shall determine 
the appropriation for each Council. Requests for addi- 
tional funds must be approved by the Board before 
they are committed. 

E. The president of the Society, the speaker of the House 
and the chairman of the Board shall be ex-officio mem- 
bers without vote of the various Councils, and may 
attend all committee meetings. 

F. Terms of office of members of the councils shall be 
one year, but may be terminated at any time at the 
discretion of the Board. No member of a council shall 
serve more than five consecutive one-year terms. 

G. Vacancies on any council or subcommittee thereof 
may be filled or membership therein may be enlarged 
or decreased by the Board of Trustees. The areas of 
concern of councils may also be enlarged or decreased 
by the Board of Trustees. 

H. The chairman of a council or subcommittee thereof, 
when he considers it expedient and with the consent 
of two-thirds of the members of the council, may 
conduct business or hold meetings by mail or bv 
conference call, provided all members of the council 
are given opportunity to participate, that minutes of 
the transactions are recorded, approved by members 
participating, and circulated among all members. 

I. Reports of subcommittees shall be made by the chair- 
man to the council under which they are operating. 

Reports of council activities shall include recom- 
mendations on reports and requests from subcommit- 


tees, and shall be made to the Board of Trustees by 
the chairman of the council. 

The chairman of any subcommittee may request the 
Board of Trustees to allow him, or any member of 
his subcommittee, to appear before the Board and 
to be heard. 

All councils shall submit to the House of Delegates 
written reports summarizing all actions. Requests for 
House action or recommendations affecting medical 
society policy must be submitted to the House in 
resolution form. 


J. Affiliate Societies 

1. Qualifications. Affiliate societies shall be those recog- 
nized societies of Illinois 

a) as may be approved by the Board of Trustees 

b) which desire representation on the Council on 
Affiliate Societies 

2. Representation. Each affiliate society shall be en- 
titled to one member on the council. This repre- 
sentative shall be a member of ISMS. 

Section 4. House of Delegates Committees. House of Dele- 
gates Committees of the Illinois State Medical Society shall 
be as follows: 

A. Committee on Credentials shall consider all ques- 
tions regarding the registration and credentials of the 
delegates. It shall distribute and receive the attend- 
ance slips for each session of the House of Delegates 
and perform any other duties assigned to it. 

B. Committee on Rules and Order of Business shall con- 
sider all matters regarding rules governing action, 
method of procedure and order of business for the 
House of Delegates. 

C. Committee on Tellers and Sergeants-at-Arms shall: 

1. Serve the speaker of the House of Delegates. 

2. Distribute, collect and tally votes when a ballot is 
taken or a numerical tally is required. 

3. Certify those in attendance in closed or executive 
sessions of the House of Delegates. 

D. Committee on Changes in the Constitution and Bylaws 
shall consider all proposed amendments to the Con- 
stitution and Bylaws. The chairman of the Trustees 
Committee on Constitution and Bylaws, or his repre- 
sentative, shall serve in an advisory capacity to this 
reference committee and shall attend all sessions, in- 
cluding the executive sessions of the reference com- 
mittee, to assist in the preparation of the report of 
the committee to the House of Delegates. 

E. Ad hoc committees may be appointed by the speaker 
of the House of Delegates as the needs arise and any 
member of the Illinois State Medical Society may serve 
upon such committee. The number appointed to 
such committees shall be at the discretion of the 
speaker and the term of the committee shall be for 
such duration as is necessary to complete the task 
assigned but shall not exceed a duration of one year. 
Between meetings of the House of Delegates ad hoc 
committees shall report to the Board of Trustees, 
keeping it informed of all current activities. 


278 


Illinois Medical Journal 


F. Such other reference committees as the speaker shall 
deem necessary to conduct the business of the House, 
or consider the reports of officers, trustees, executive 
administrator, the reports of committees pertaining 
to administrative activities, economics activities, scien- 
tific activities, public relations activities and legisla- 
tive activities, as well as such resolutions, reports, and 
proposals as shall be brought before the House of 
Delegates. 

Section 5. Organization of House of Delegates Commit- 
tees. 

A. Immediately after the organization of the House of 
Delegates at each annual or special meeting, the 
speaker shall announce the appointment from among 
the members of the House, of such committees as 
may be deemed expedient by the House of Delegates. 

Each committee shall consist of five or more mem- 
bers unless otherwise provided, the chairman to be 
announced by the speaker. These committees shall 
serve during the meeting at which they are appointed. 

B. References, resolutions, measures and propositions pre- 
sented to the House of Delegates shall be referred to 
the appropriate committee, which shall report to the 
House of Delegates before final action shall be taken. 
A two-thirds affirmative vote of the House of Dele- 
gates shall be required to suspend this rule. 

C. Each reference committee shall, as soon as possible 
after the adjournment of each session, or during the 
session if necessary, take up and consider such busi- 
ness as may have been referred to it, and shall report 
on same at the next session, or when called upon 
to do so. 

Section 6. Board of Trustees Committees. The Board of 

trustees shall form the following committees within 

itself: 

A. The Executive Committee shall consist of the president, 
president-elect, the first vice president, the chairman of 
the Board, the chairman of the Finance and Medical 
Benevolence Committee, the chairman of the Policy 
Committee, the secretary-treasurer, the trustee-at-large, 
and the immediate past chairman of the Board, pro- 
vided he is still a trustee. 

The Board of Trustees may delegate to the execu- 
tive committee any authority which it possesses and 
may authorize it to act in any given situation. In 
all matters of routine administration, special plans, 
policy, endorsement or expenditure it shall report to 
and request approval of the Board. It shall receive 
the reports of the Finance and Medical Benevolence 
Committee and Policy Committee and make recom- 
mendations concerning them to the Board. It shall 
furnish a report of its actions to the Board at each 
meeting. 

B. The Finance and Medical Benevolence Committee 
shall consist of the secretary-treasurer of the Society 
and three members of the Board appointed by the 
chairman. It shall develop for approval of the Board 
through the Executive Committee, a budget for the 
fiscal year. It shall supervise the financial transactions 


of the Society. It shall make recommendations to the 
Board for the control and investment of the funds 
of the Illinois State Medical Society. 

This committee shall also: 

1. Examine applications to the Society for assistance 
under the Medical Benevolence to determine eligi- 
bility for assistance; 

2. Keep the names of the beneficiaries confidential 
and known only to the committee; 

3. Recommend the allotment for each recipient; and 

4. If funds available become inadequate to meet dis- 
bursements, request the Board of Trustees to ap- 
propriate sufficient funds to support the program 
until the next budget appropriation. 

C. The Policy Committee shall consist of three mem- 
bers of the Board appointed by the chairman. It 
shall continually review past and current proceedings 
of the House of Delegates to determine the estab- 
lished policies of the Illinois State Medical Society. It 
shall make recommendations for future policy by 
Board resolution to the House of Delegates. 

D. The Ethical Relations Committee shall be constituted 
and function as stipulated in Chapter XI, Discipline, 
Part 2, Illinois State Medical Society procedures. 

E. The Committee on Constitution and Bylaws shall con- 
sist of five members of the Board appointed by the 
chairman and it shall: 

1. Receive from individual members, county societies, 
committees, the Board of Trustees, and the House 
of Delegates, all suggestions and proposals for modi- 
fication of the Constitution and Bylaws. 

2. Prepare for the consideration of the House of Dele- 
gates, all changes in the Constitution and Bylaws. 

3. Maintain constant surveillance of both documents 
to keep them current, effective and consistent with 
the policies of the House of Delegates. 

F. The Committee on Publications shall be composed 
of five members of the Board of Trustees, and shall 
be responsible for the production of the Illinois 
Medical Journal. 

It shall recommend to the Board of Trustees all 
policies governing the editorial, business and produc- 
tion aspects of the Journal. It shall supervise the edi- 
tor in the selection and preparation of all copy, and 
it shall establish standards for the editorial content. 

It shall establish advertising policies, rates, stand- 
ards, and shall review all new accounts prior to ac- 
ceptance, and shall approve reprint and circulation 
policies. 

It shall conduct a periodic review of the printer’s 
contract and solicit bids as indicated. It shall establish 
format, cover, type faces and general layout of the 
Journal. 

It shall review, edit and supervise the publication 
of other materials as directed by the Board of Trustees. 

G. The Advisory Committee to the Woman’s Auxiliary 
shall consist of the president-elect as chairman, the 
president and the chairman of the Board of Trustees. 


for October, 1974 


279 


The committee shall provide advice and assistance 
to the president of the Woman’s Auxiliary in her pro- 
gram for the year, and shall assist her in interpreting 
the activities of the Illinois State Medical Society. 

H. The Board of Trustees may from time to time ap- 
point such ad hoc committees as it may deem neces- 
sary but the duration of such committees shall be 
temporary and they shall function only for the speci- 
fic purpose assigned and shall be terminated as soon 
as final reports have been made or at the direction 
of the Board. 

Section 7. Powers of the Board of Trustees. The Board 
of Trustees shall have power to increase or decrease the 
number of its committees, to change the area of concern 
of such committees, to enlarge or decrease membership 
and to fill vacancies thereon. 

Section 8. Term of Membership. The term of the mem- 
bers of the Board of Trustees Committees shall be for 
a duration of one year and they shall be selected by the 
Board annually immediately after the election of officers. 


CHAPTER X. COUNTY SOCIETIES 

Section 1. All county societies now in affiliation with this 
Society, or those which may hereafter be organized in this 
state, which have adopted principles of organization in 
harmony with this Constitution and Bylaws, shall upon 
application to and approval by the Board of Trustees, 
receive a charter from and thereby become a component 
part of this Society, and members thereof shall become 
members of this Society and the American Medical 
Association. 

Section 2. Charters shall be issued only on approval of 
the Board, and shall be signed by the president and the 
secretary of this Society. 

The Board shall have authority to revoke the charter 
of any component society whose actions are in conflict 
with the letter and spirit of this Constitution and Bylaws. 

Section 3. Only one component medical society shall be 
chartered in any county. 

Section 4. Every registered physician holding the title of 
Doctor of Medicine or its equivalent, who either (1) 
resides in the jurisdiction of a component society, or (2) 
resides in a state other than Illinois but practices prin- 
cipally in the jurisdiction of a component society and 
who is of good moral character and professional standing, 
shall be eligible to membership in that component society. 

The component county society shall be the sole judge 
of the qualifications of its members, subject only to the 
stipulations contained in the Constitution and Bylaws. 

Section 5. Any physician who has been disciplined by any 
action of a component society and believes he has not 
had a fair trial, shall have the right of appeal to the 
Board of Trustees. 

Section 6. When a member in good standing in a com- 
ponent society changes his residence to another county 


in this state, such change of residence shall terminate his 
membership in such component society. (This ruling shall 
not apply to members in military service or in the service 
of the State or the United States government.) 

Such member shall be entitled, upon his request, to a 
statement from his former secretary as to his standing. 
This statement of standing shall be issued without cost 
to the applicant. 

He shall present this statement to the component so- 
ciety of the county to which he removes and it shall ac- 
company his application for membership. The board of 
censors of the society receiving this application shall give 
this statement of prior standing due consideration before 
accepting or rejecting his application for membership. 

Section 7. A physician living on or near a county line, 
or practicing partly or totally in an adjacent county, may 
hold his membership in the county most convenient for 
him, provided he submits written authorization to that 
society from the component society in whose jurisdiction 
he resides. 

Section 8. The secretary of each component society shall 
keep a roster of its members, in which shall be shown 
the full name, address, college and date of graduation, 
date of license to practice in this state, and such other 
information as may be deemed necessary. In keeping such 
a roster the secretary shall note any changes in the per- 
sonnel of the profession by death or by removal to or 
from the county. When requested, he shall furnish on 
blanks supplied him for the purpose, an official report 
containing such information for the secretary of this 
Society and likewise for the trustee of the district in 
which his county is situated. 

Section 9. The secretary of each component society shall 
forward its roster of officers and members, and a list of 
delegates and alternate delegates to the secretary of this 
society no later than 120 days prior to annual meeting. 

Section 10. Any component society which fails to pay its 
assessment or make the annual report required on or 
before March fifteenth shall be held as suspended and 
none of its members shall be permitted to participate in 
any of the business or proceedings of the Society or of 
the House of Delegates until such requirements have 
been met. 

A member is in good standing unless otherwise dis- 
qualified, whose dues are paid on or before the first day 
of March of the current year. Immediately after the first 
of March, each delinquent member shall be notified that 
in consequence of nonpayment of dues, his membership 
is delinquent. If dues remain unpaid as of June thirtieth 
of the current year, membership shall be dropped auto- 
matically. The member may be reinstated by paying all 
delinquent dues, provided, in the interim, he has not been 
guilty of conduct prejudicial to membership; but if two 
or more years have elapsed since he was a member in 
good standing, he must in addition, make application 
as a new member. 

Section 11. The Constitution and Bylaws of the Illinois 
State Medical Society and of the American Medical Asso- 
ciation, together with the Principles of Medical Ethics 
of the American Medical Association, shall be binding 
upon the members of the component societies. 


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Illinois Medical Journal 


CHAPTER XI. DISCIPLINE 

PART 1. COMPONENT SOCIETY PROCEDURE 

Section 1. Local Ethical Relations Cornmittee. Each com- 
ponent society may have, either by appointment or elec- 
tion, an Ethical Relations Committee, whose duty it shall 
be to prosecute formal charges of unethical conduct. In 
the event that the county society does not have such a 
committee, the district Ethical Relations Committee shall 
function in its behalf. 

All parties may have legal counsel present to advise 
and counsel them during the proceedings, but such coun- 
sel may not participate in the proceedings, and may be 
excluded from the hearing by the chairman or by vote 
of the committee. 

The component society Ethical Relations Committee 
may establish reasonable rules of procedure, and they 
shall not be bound by the technical rules of evidence as 
l he same pertain in courts of law. In all proceedings be- 
fore such Ethical Relations Committees, the complainant, 
the accused and all witnesses before the committee shall 
be placed under oath. 

The Committee shall evaluate acts by the standards 
established by the House of Delegates of the American 
Medical Association (specifically known as the Principles 
of Medical Ethics of the American Medical Association), 
and by such additional standards as shall be incorporated 
in the Constitution and Bylaws of the Illinois State Medi- 
cal Society and/or the county medical society. 

Section 2. Offenses. Any member of a component society 
shall be subject to censure, suspension or expulsion by 
such component society when 

A. He has been adjudged guilty by proper civil authori- 
ties of a criminal offense involving moral turpitude, or 

B. He has been adjudged guilty by his component so- 
ciety in accordance with the procedural requirement 
of these bylaws: 

1. of a gross misconduct as a physician, or 

2. of a violation of the Constitution or Bylaws of his 
component society, or of the Illinois State Medical 
Society, or of the Principles of Medical Ethics pro- 
mulgated from time to time by the American Med- 
ical Association. 

Section 3. Charges Initially Presented to the Illinois State 
Medical Society. Original complaints received by the Illi- 
nois State Medical Society shall be referred directly to the 
secretary of the component society of which the accused 
is a member or to the district Ethical Relations Com- 
mittee. 

Section 4. Principles of Justice. The following principles 
of justice shall guide the Ethical Relations Committee 
in all disciplinary procedures. 

A. An accused is presumed to be innocent until he has 
been proven guilty. 

B. Formal charges before the Ethical Relations Committee 
of the component society or district Ethical Relations 
Committee must be presented under oath by the 
complaining party. 

C. A trial shall be held by the committee within 30 days 
after the formal charges have been filed, unless con- 
tinued by the chairman of the committee upon good 
cause shown. 


D. The individual against whom formal charges have 
been filed shall be sent a copy of said charges by cer- 
tified mail at least 10 days before the date set for 
the trial, together with a statement of the rights of 
the accused as follows: 

1. to be represented by any member of the society 
as counsel and that he may have legal counsel 
present; 

2. to cross-examine witnesses; 

3. to offer in evidence any pertinent records or docu- 
ments: 

4. to object to any testimony or exhibits offered in 
evidence; 

5. to address the trial body in his own behalf; 

6. to be tried only on the specific charges filed; 

7. to have stricken from the record any improper 
testimony or exhibits; 

8. to appeal to the Board of Trustees of the Illinois 
State Medical Society. 

Section 5. Records. A comprehensive stenographic record 
of the proceedings, together with all exhibits, must be 
kept for reference, and shall be available until final 
adjudication has been made 

In the event of an appeal being taken from the verdict 
of the local or district Ethical Relations Committee, the 
stenographic record shall be forwarded by certified mail 
to the Board of Trustees of the ISMS at least ten days 
prior to the date the appeal is to be heard. 

If the component society fails to provide the record 
on appeal, the Ethical Relations Committee of Illinois 
State Medical Society shall find the accused not guilty. 

Section 6. Verdict. The committee, sitting as a trial body, 
shall find the accused either guilty or not guilty. If the 
verdict is guilty, the trial body shall recommend censure, 
suspension or expulsion. 

The findings of the trial body must be presented to the 
component county society for approval or rejection. The 
accused must be notified by certified mail at least ten 
days before the date set for the meeting at which this 
action will be taken. If the findings of the trial body are 
against the accused the secretary of the component society 
shall acquaint the accused, by certified mail, with his 
right of appeal within thirty days to the Board of Trus- 
tees of the Illinois State Medical Society. 

PART 2. ILLINOIS STATE MEDICAL 
SOCIETY PROCEDURES 

Section 1. Illinois State Medical Society Ethical Relations 
Committee. The Board of Trustees shall appoint from 
its members, an Ethical Relations Committee to review 
decisions of the component society involving the inter- 
pretation of the Principles of Medical Ethics, violations 
of the Constitution and Bylaws of the Illinois State Medi- 
cal Society or its component societies, and charges of mis- 
conduct of members of the Society. 

Section 2. Appeals from Component Society Verdicts. 
Appeals received by the Illinois State Medical Society 
Board of Trustees shall be referred to the Ethical Rela- 
tions Committee of the Board for review. (Appeals must 
oe accompanied by a comprehensive stenographic record 
of the proceedings taken before the component county 
society together with all exhibits submitted in evidence. 
If the component county society fails to provide the 
record on appeal, the Ethical Relations Committee of the 


for October, 1974 


281 


Illinois State Medical Society shall find the accused “not 
guilty”). The committee shall notify the accused and the 
secretary of the component society by certified mail at 
least thirty days prior to the date set for the hearing of 
the appeal. The chairman of the committee shall preside 
over the hearing in accordance with the rules established 
by the Board of Trustees. 

Section 3. Verdict. The Ethical Relations Committee of 
the Board of Trustees shall hear any new and pertinent 
evidence any interested party desires to present, and at 
the conclusion of the trial the decision of the component 
society shall be affirmed, overruled or sent back to the 
component society for reconsideration. 

Section 4. Notification and right of appeal. The secretary 
of the Society shall notify the defendant and the secre- 
tary of the component society wherein the defendant holds 
membership, of the action of the Board. In the event of 
a decision against the accused he shall have the right to 
appeal the decision to the Judicial Council of the Ameri- 
can Medical Association and the secretary of the State 
Society shall so notify the accused of this right. 

CHAPTER XII. PEER REVIEW 

PART 1. COMPONENT SOCIETY PROCEDURE 

Section 1. Local Peer Review Committee. Each compon- 
ent Society shall have, either by appointment or election, 
a Peer Review Committee whose duties it shall be to 
review all proper complaints and inquiries brought be- 
fore it by physicians, patients, institutions, insurance car- 
riers, or government agencies. 

The district peer review committee shall function and 
operate on behalf of any county society which does not 
establish such a committee. 

Section 2. The committee shall consist of a chairman and 
such members representing the various specialties, includ- 
ing family practice, as each individual county society shall 
determine. Such committee should have access to counsel 
from each of the various medical specialties. The com- 
ponent county society may establish reasonable rules of 
procedure but shall not be bound by the technical rules 
of evidence as the same pertains in courts of law. All 
proper complaints shall be reduced to writing and shall 
be signed by the individual making the complaint. 

Section 3. Original complaints received by the Illinois 
State Medical Society shall be referred to the proper 
county society or to the district committee. 

Section 4. The Peer Review Committee shall include the 
functions of the grievance committee, the prepayment 
plans and organizations committee, the mediation com- 
mittee and any other committee having to do with in- 
vestigations and review but shall not replace or super- 
sede the ethical relations committee. 

Section 5. The Peer Review Committee shall initiate con- 
sideration of all complaints and matters filed with it 
within 60 days from the date of filing and shall render 
an opinion within 30 days after the conclusion of the 
hearing. In the event the committee does not follow this 
procedure any party may appeal for relief to the proper 
district committee whose procedure shall be the same 
as is set forth herein for county societies. 

Section 6. The Peer Review Committee shall have no 
disciplinary powers but instead, shall report its findings 


in writing to all parties involved. In the event the in- 
vestigation and study of the committee results in a de- 
termination that there has been a violation of law or 
unethical conduct on the part of any physician, or a 
violation of the Constitution or Bylaws of his compon- 
ent society, or of the Illinois State Medical Society, or 
of the Principles of Medical Ethics promulgated from 
time to time by the American Medical Association, the 
matter shall be referred in writing to the component 
society. 

Section 7. In its study and deliberations the Peer Review 
Committee shall evaluate acts by the standards established 
by the House of Delegates of the American Medical Asso- 
ciation (specifically known as the Principles of Medical 
Ethics of the American Medical Association), and by such 
additional standards as shall be incorporated in the Con- 
stitution and Bylaws of the Illinois State Medical Society 
and/or the county medical society. 

Section 8. Any party to the proceedings considering him- 
self aggrieved by the findings and recommendations of 
the committee shall have the right to appeal through the 
component society to the Illinois State Medical Society. 

Section 9. In the event of an appeal to the Illinois State 
Medical Society, the county society shall send to the 
Illinois State Medical Society a copy of the complaint, 
the exhibits and the opinions of the county or district 
committee. Any appeal hereunder shall be filed with the 
Illinois State Medical Society wihin 30 days after the final 
opinion of the county or district committee has been 
rendered. 

PART 2. ILLINOIS STATE MEDICAL 
SOCIETY PROCEDURES 

Section 1. All appeals received by the Illinois State 
Medical Society shall be referred to the Council on 
Economics and Peer Review, which shall review opinions 
of the county or district peer review committee. The coun- 
cil shall have the power to counsel with and obtain infor- 
mation from medical specialists when appropriate. The 
Council shall have the power to review both the procedural 
and substantive aspects of any appeal before it. 

Section 2. The council upon receiving notice of an ap- 
peal shall set the matter for hearing within 30 days after 
the appeal has been filed and at such hearing shall re- 
view the record sent to it from the county society or dis- 
trict society, receive additional pertinent evidence any 
interested party desires to offer and render its conclu- 
sions and findings in writing, copies of which shall be 
mailed to all interested parties. The Peer Review Com- 
mittee shall have no disciplinary powers but instead, shall 
report its findings to all parties involved. The conclu- 
sions and findings shall be advisory only. 

Section 3. The Council on Economics and Peer Review 
of the Illinois State Medical Society shall include the 
functions of the grievance committee, the prepayment 
plans and organizations committee, the mediation com- 
mittee and any other committee having to do with in- 
vestigations and review but shall not replace or supersede 
the ethical relations committee. 

Section 4. In the event the investigation and study of 
the Council results in a determination that there has 
been a violation of law or unethical conduct on the part 
of any physician, or a violation of the Constitution or 


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Illinois Medical Journal 


Bylaws of his component society, or of the Illinois State 
Medical Society, or of the Principles of Medical Ethics 
promulgated from time to time by the American Medical 
Association, the matter shall be referred in writing back 
to the component society. 

CHAPTER XIII. MISCELLANEOUS 

The fiscal year of this Society shall be from January 1 to 
December 31 inclusive. 

CHAPTER XIV. AMENDMENTS 
The House of Delegates may amend any article of these 


Bylaws by a two-thirds vote of the delegates present at 
any meeting, provided that such amendment shall not 
be acted upon before the day following that on which 
it was introduced. 

CHAPTER XV. PARLIAMENTARY PROCEDURES 

For those matters not covered by the Constitution and 
Bylaws of the Illinois State Medical Society, Sturgis Stan- 
dard Code of Parliamentary Procedure, Current Edition, 
shall be the guide for conduct of meetings of the House 
of Delegates, Board of Trustees and all councils and com- 
mittees. 


Index to Constitution and Bylaws 


Ad hoc Committees 278 

Advisory Committee to Woman's Auxiliary 279 

Affiliate Societies 

Council on 277 

organization 278 

Amendments 

to the Bylaws 283 

lo the Constitution 272 

American Medical Association 

membership 272 

Annual Dues, Assessments 273 

Audit and Financial Statement 276 

Benevolence Fund 276 

Board of Trustees 

committees 279 

composition 275 

election by House of Delegates 279 

election of Chairman 276 

duties 276 

meetings 276 

organization 276 

powers 280 

quorum 276 

term of office 280 

vacancies 276 

Bonding of officers and employees 276 

Bylaws 272 

Changes on Constitution and Bylaws Committee 279 

Component Societies 272 

Composition 274 

procedure .... 281 

Composition of the Society 272 

Constitution and Bylaws, Committee on 279 

Conventions and Meetings 272 

Education and Scientific Programs 274 

House of Delegates 274 

Councils (standing committees) 

duties 277 

organization of 277 

reports 278 

terms of office 278 

vacancies 278 

County Societies, Organization of 276 

Credentials Committee 278 

Discipline 

Component Society Procedure 281 

State Medical Society Procedure 281 

District Committees 276 

Economics and Peer Review, Council on 277 

Education and Manpower, Council on 274 

Education and Scientific Programs 274 


Environmental and Community Health, Council on 277 

Ethical Relations Committee 279 

Executive Administrator 276 

Executive Committee 279 

Finance and Medical Benevolence Committee 279 

Governmental Affairs, Council on 277 

House of Delegates 

composition 274 

delegates 274 

district divisions 274 

elections 274 

meetings 274 

order of procedure 274 

term of office 275 

House of Delegates Committee 279 

duties 279 

elections 274 

organization 279 

Membership 

associate members 273 

discrimination of membership 273 

distinguished members 273 

emeritus members 273 

in-training members 273 

provisional members 272 

regular members 272 

retired members 273 

service members 273 

tenure and termination of membership 273 


Officers 

elections 275 

duties 275 

terms of office 275 

Medical-Legal, Council on 277 

Mental Health and Addiction, Council on 277 


Miscellaneous 

Parliamentary Procedures 

Peer Review 

Component Society Procedures 


State Medical Society Procedure 282 

Policy Committee 279 

Publication Committee 279 

Public Relations and Membership Services, Council on ....277 

Reference Committees 279 

Rules and Order of Business Committee 278 

Seal, the 272 

Social and Medical Services, Council on 277 

Tellers and Sergeants-at-arms Committee 278 

Woman's Auxiliary, Advisory Committee to 279 


for October, 1974 


283 


1974-1975 

Policy Manual 
of the 

Illinois State Medical Society 

"Policy statements shall be defined as guidelines for the management of the Illinois State Medical 
Society affairs, based upon prudence, sound judgment and experience.” 

“Rules and regulations may be prepared by the Board of Trustees or by committees, for use in 
the implementation of policy.” 


This manual shall be a guide for officers, trustees, com- 
mittee chairmen and headquarters staff to the stand 
taken by the House of Delegates of the Illinois State 
Medical Society on all issues involving Society policy. 

Its statements shall combine and reconcile the best 
expressions made on all phases of policy involving the 
House of Delegates, the Board of Trustees and the various 
committees. 

All policy statements (except those involving the funds 
of the Society) shall have the approval of the House of 
Delegates, since the Constitution and Bylaws provide in 
ARTICLE V: 

“The House of Delegates shall set the basic policy and 
philosophy of the Society.” 

All policy statements developed during the interval 
between meetings of the House shall be submitted at its 
next meeting for action. The House may: 

(1) approve, amend, or reject— 

(2) refer the statement to the Board for reconsideration 
and subsequent report— 

(3) remand the statement to the committee from which 
it came for further study and report. 

Policy statements for the consideration of the House 
may appear as a portion of the annual report of the 
Policy Committee, or they may be contained in other re- 
ports to the House. The final statements for publication 
in this Policy Manual are to be prepared by the Policy 
Committee. Any member of the Illinois State Medical 
Society may submit a policy statement for consideration. 

Temporary policy between meetings of the House is 
determined by the Board. Committees may request Board 
consideration at any time. 

The Illinois State Medical Society shall support policy 
statements approved by the House of Delegates of the 
American Medical Association. 

National policy is the prerogative of the national asso- 
ciation. Until specific contrary action emanates from the 
AMA House of Delegates, the Board of Trustees and the 
officers of the ISMS shall consider all such policy as 
binding. 

Policy action at the state level does not rescind official 
AMA rulings in Illinois. 

The same “chain of command” should exist between 
the county medical society and the ISMS House of Dele- 
gates. Policy established at the State Society level must 
prevail until majority action by the House of Delegates 
has rescinded or reversed the statements. This represents 
“majority rule” and must be followed closely to preserve 
the democratic process. 


PROFESSIONAL POLICIES 
Abortion 

The decision to perform an abortion is a medical matter 
to be determined by agreement between the patient and 
the physician. Performance of abortions should be carried 
out in accordance with current guidelines as promulgated 
by the House of Delegates. If not in conflict with state 
and federal law, an abortion so performed shall not be 
considered unethical. No physician shall be required to 
perform or participate in an abortion. 

Alcoholism 

Alcoholism is an illness characterized by preoccupation 
with alcohol and loss of control over its consumption such 
as to lead usually to intoxication if drinking is begun; 
by chronicity; by progression, and by tendency toward 
relapse. It is typically associated with physical disability 
and impaired emotional, occupational and/or social ad- 
justments as a direct consequence of persistent and 
excessive use of alcohol. 

Insurance companies are encouraged to include appro- 
priate coverage for alcoholism in health insurance policies 
similar to coverage for any other illness and general 
hospitals, both public and private, are encouraged to 
accept alcoholic patients (both in-patient and out-patient) 
for detoxification and rehabilitation. 

Alcoholism Education 

The Illinois State Medical Society supports the concept 
that medical schools and hospital training programs 
should expand instruction of students in the treatment 
of acute and chronic alcoholism, as well as its cause and 
prevention; that mental health clinics should enlarge 
their services to include treatment and counseling of 
alcoholics and their families and, where appropriate, col- 
laborate with Alcoholics Anonymous as well as half-way 
houses; that education programs aimed at alcohol abusers 
who are drivers should be encouraged and legal restric- 
tions established to prevent them from holding drivers’ 
licenses; that education of the public (at all age levels) 
regarding the nature of alcohol and its physiologic and 
psychologic effects should be encouraged. 

Ambulance Services 

All ambulance services should meet minimum stand- 


284 


Illinois Medical Journal' 


ards as developed from time to time by the Illinois State 
Medical Society and the State of Illinois. 

Athletic Programs 

Children of school age, through the 9th grade, should 
not participate in body contact sports. 

Elementary school children develop better physically 
if activities are informal and not highly competitive. 
Medical supervision of all athletic programs is essential. 

Audits & Surveys 

(Hospital, nursing homes, etc.) 

Audits and surveys which impinge on personal privacy, 
patient care and local hospital trustee and medical de- 
cisions as to management should not be condoned. 

Birth Control 

The preventive medicine approach to the problem of 
unwanted pregnancies should he encouraged through 
family life education in the schools, wider dissemination 
of family planning information, including birth control 
information and devices, and encouragement of research 
in population control methods. 

Blood Procurement 

Inasmuch as blood procurement affects the entire 
community, any blood procurement program should he 
carried out only with the approval of the local county 
medical society involved. 

Communicable Diseases 

Physicians, especially those engaged in public health 
work, should enlighten the public concerning all regula- 
tions and measures for the prevention and control of 
communicable diseases. When an epidemic prevails, a 
physician shall continue his labors without regard to his 
own health. 

Community Health Week 

The medical profession shall provide the scientific 
leadership to focus attention on the health needs of the 
community and to encourage and assist in developing 
Community Health Week activities during the winter or 
spring of the year. 

Comprehensive Health Planning 

Upgrading of local health facilities should be imple- 
mented through Comprehensive Health Planning on a 
home rule basis rather than through metropolitan or- 
iented advisory services. Where a county medical society is 
unable to enter into meaningful participation in areawide 
health services planning, this function may be assumed by 
an appropriate ISMS District Committee or, where the 
appropriate District Committee is unable to act, by the 
Illinois State Medical Society. 

Confidentiality 

Communications received in confidence by physicians 
from patients are privileged: the privilege is that of the 
patient and the physician is the guardian of the privilege 
and must not betray it. Current day social values dictate 
that privileges must be continued in accomplishment of 
the treatment of human illness. Section 9 of the Principles 


of Medical Ethics states that “A physician may not reveal 
the confidences entrusted to him in the course of medical 
attendance, or the deficiencies he may observe in the 
character of patients, unless he is required to do so by 
law or unless it becomes necessary in order to protect the 
welfare of the individual or the community.” The Illinois 
State Meclcial Society re affirms its belief in this principle 
and supports activities to guarantee continuation of pri- 
vacy, while recognizing the need for collection of statistical 
data and enforcement activities in the public good. 

Conflict of Interest 

When a case of conflict of interest arises and is self- 
evident, by the attitude shown by the individual con- 
cerned, it should be referred to the Executive Committee 
of the Board of Trustees of the ISMS for consideration. 

Continuing Education 

Continuing education shall be one of the basic purposes 
of the Illinois State Medical Society for scientific advance- 
ment, humanization of medicine, improvement of med- 
ical public relations, and development of cooperation and 
rapport with the public. The Society should continue to 
support the multi-faceted approach to continuing medical 
education as now endorsed by the Illinois Council on 
Continuing Medical Education. 

All members should be encouraged to participate in the 
AMA Physician Recognition Award, as presently con- 
stituted, or its equivalent. 

In the certification of educational quality of continuing 
medical education programs, the Illinois State Medical 
Society should have a primary role. Physicians should be 
encouraged to participate in self-assessment test programs 
prior to registering for such hospital courses and other 
learning activities. 

Cultists, Association with 

The Judicial Council of the American Medical Associa- 
tion has ruled that it is unethical to associate VOLUN- 
TARILY with an individual who practices as a member 
of a “cult.” 

Disaster Control 

Any disaster creates an obvious need for trained per- 
sonnel to aid the sick and injured. Local medical societies 
should cooperate to provide medical self-help programs. 
County societies should provide training for their mem- 
bership in the treatment of mass casualties, radiological 
casualties and in the organization, operation and main- 
tenance of emergency hospitals. 

Discrimination — (see “Freedom of Choice”) 
Drugs, Prescriptions 

Substitution of prescribed drugs by pharmacists is op- 
posed, except in cases of extreme emergency, unless there 
he full explanation and agreement by both the patient 
and the doctor. 

Ethics 

Cases involving ethics shall reach the state society level 
only by means of an appeal. As outlined in the Bylaws, 
the state society committee shall serve only as an appellate 
body to review such cases. 


for October , 1974 


285 


Examinations 

All physical examinations should be performed in the 
physician’s office. No examinations should be conducted 
on a group basis unless authorization has been given by 
the local county medical society in a single instance or 
for a specific purpose. 

This general statement does not apply to the industrial 
or occupational health physican in his in-patient activities. 

Experimental Medical Procedures 

In order to conform to the ethics of the American 
Medical Association, three requirements must be satisfied 
in connection with the use of experimental drugs or 
procedures: 

1. The voluntary consent of the person on whom the 
experiment is to be performed should be obtained. 

2. The danger of each experiment must lie previously 
investigated by animal experimentation. 

3. The experiment must be performed under proper 
medical protection and management. 

Fee Schedules 

No member or committee shall be permitted to approve 
a fee schedule for the Illinois State Medical Society until 
it has been submitted to and approved by the House 
of Delegates or the Board of Trustees. Fees should be 
commensurate with services rendered. 

Freedom of Choice 

The mutual right of physicians and patients to exer- 
cise freedom of choice in medical matters shall be main- 
tained. This includes the right of the patient to choose 
the physician by whom he will be served, and the right 
of the physician (except in emergencies) to a correspond- 
ing freedom of choice. All members of the Illinois State 
Medical Society enjoy the same rights and privileges and 
are bound by the same obligations and standards of pro- 
fessional conduct. 

Foundations for Medical Care 

The Illinois Foundation for Medical Care is a not-for- 
profit corporation established to provide physicians with 
leadership roles in modifying health care delivery in their 
communities, thus assuring quality care at reasonable 
cost. Establishment of autonomous county and/or multi- 
county foundations under the sponsorship of local med- 
ical societies is encouraged and, together, local and state 
foundations shall provide a mechanism through which 
foundation-sponsored programs can be developed and ad- 
ministered throughout the state. 

Health Care — Ancillary Services 

All segments of our population are entitled to and shall 
receive the best health care available. The physicians in 
Illinois are encouraged to cooperate in the implementation 
of any national program meeting with the general policy 
statements of the Society. (This shall be interpreted to 
include health aspects in nursing home care, use of rec- 
reational facilities, environmental health, public health, 
employment problems, problems of migrant workers, etc., 
and any other area which involves the health of the 
people of this state.) 


Health Care Costs 

The public should be educated concerning the differ- 
ence between ‘‘health care costs” and “medical care costs.” 
Members of the profession should cooperate with the 
various ancillary groups and should be able to explain 
the cost factors involved in total care. 

Health Careers 

All capable and worthy individuals interested in medi- 
cine as a career shall be encouraged and assisted by the 
Illinois State Medical Society. Those interested in para- 
medical fields shall be provided with all pertinent in- 
formation. 

Health Screening by Paramedical Personnel 

Health evaluation, to be adequate, must include a 
physical examination only by or under the direct super- 
vision of a physician licensed to practice medicine in all 
of its branches with physician interpretation of the ap- 
propriateness and reliability of various screening proce- 
dures used. 

Hospitals 

Physicians should sponsor and assist in the development 
of all medical staff committees within the hospital. 

The local medical profession should cooperate to 
achieve the accreditation of all eligible hospitals, and 
should encourage the stabilization or reduction of hos- 
pital costs in all areas where they have authority. 

Hospital-Medical Staff-Management 
Relationship 

Any proposal or arrangement between institutional 
management and medical staffs should not conflict with 
the Principles of Medical Ethics or abridge the property 
right endowed upon the individual physicians by the 
Illinois Department of Registration and Education. The 
practice of medicine is the physician’s legal prerogative 
and responsibility. To insure the quality of medical care, 
each hospital has the obligation to cooperate with and 
assist its medical staff in implementing procedures by 
which the quality of medical care in that hospital may 
be maintained by and through its medical staff. 

Hospital Records and Their Availability 

Hospital records are privileged information and the 
property of the patient, kept in trust by the hospital. 
They are not to be released except on a court order. 

Upon receipt of a request signed by the patient, an 
abstract or a summary shall be provided when needed, 
to insurance companies, governmental agencies, consult- 
ing physicians, etc. 

Hospital Staff Assessments 

The medical staff of a hospital does not have the priv- 
ilege or the right to make compulsory assessments of 
members of the medical staff for building funds, or to 
demand an audit of staff members’ personal financial 
records as a requisite for staff appointments. 

Immunization Program 

Illinois residents should be provided all types of im- 
munization. Physicians are requested to provide this pro- 


286 


Illinois Medical Journal 


tection especially to all children, or to encourage the local 
public health agency to perform this function. 

Every school should have a school health committee 
with at least one physician as a member. County ad- 
visory school health councils should assist in coordination. 

Impartial Medical Testimony 

The ends of justice are served when impartial medical 
witnesses are available to give testimony. The ISMS sup- 
ports this concept and offers its assistance in the pro- 
vision of impartial medical testimony. 

Indigent, The Care of the 

Personal medical care is primarily the responsibility of 
the individual. When he is unable to provide this care 
for himself, the responsibility should properly pass to his 
family, the community, the county, the state, and only 
when all these fail, to the federal government, and only in 
conjunction with the other levels of government in the 
order above. 

The determination of medical needs should be made 
by a physician. The determination of eligibility should 
be made at the local level with local administration and 
control. The principle of freedom of choice should be 
preserved. 

Insurance Plans for Patients 

ISMS endorses the principle of voluntary health insur- 
ance. Fixed fee schedules should be recognized as in- 
demnification to the patient and not necessarily payment 
in full. 

Inasmuch as the fee coverage by insurance plans may 
not cover the full fee of the physician, the physician is 
encouraged to develop a prior agreement with the pa- 
tient, such as the “Statement* of Understanding.” This will 
outline to the patient his individual responsibility for the 
physician’s fee. 

Laboratories 

All laboratories providing medical data should be under 
the direct supervision of a physician. 

Medical Care, Provision of 

Medical care shall be provided regardless of the ability 
of the patient to pay. Physicians shall not refuse to 
render needed emergency care to any patient. 

Medical Education 

The Illinois State Medical Society supports development 
of innovative curricular and co-curricular programs in 
medical education maintaining a firm foundation in the 
basic sciences. 

Medical Examiners 

ISMS favors a medical examiner system throughout the 
state in preference to a coronor system, wherever practical. 

Medical Psychotherapy 

Medical Psychotherapy is a medical procedure for the 
treatment of mental and physical ailments or illness. It 
involves verbal and non-verbal communications with the 
patient, and always includes continuing medical diagnostic 
evaluation and drug management as indicated. Medical 


psychotherapy may be performed only by a physician 
licensed to practice medicine in all of its branches, who 
has had training in psychiatric medicine. 

Mental Health 

The Illinois State Medical Society strongly opposes the 
double standard of care in state hospitals and favors 
elimination of permit physicians (unlicensed physicians 
practicing in state institutions). Every effort should be 
made to extend educational opportunities to these permit 
physicians to enable them to achieve full licensure. 

Each constituent county society should cooperate fully 
with and support local units of the Department of Mental 
Health in their patient care efforts, specifically seeking 
to encourage: 

1 . Local general hospitals to accept mental health pa- 
tients who can be helped by short-term treatment, 
leaving to state institutions the responsibility for 
such chronic and long-term cases which local hospi- 
tals cannot presently handle. 

2. Local general hospitals and practitioners to retain 
in their own care those geriatric patients who have 
ailments of primarily a physical nature. 

3. Local physicians, local hospitals, and local skilled 
nursing facilities to provide primary and secondary 
care for psychiatric problems to the extent possible; 
given facilities and physician-time available. 

4. Arrangements for emergency mental health care, i.e., 
crisis intervention, to be available areawide. 

All physician or other health service provided to the 
Department of Mental Health, other than that by full- 
time employees, should be on the same fee-for-service 
basis as any other medical service which is paid by the 
patient or third party insurer. 

A physician licensed to practice medicine in all its 
branches should be required to certify the discharge of 
any patient from a psychiatric institution. 

Minors, Medical Treatment of 

Where parental consent is not legally required for 
medical treatment of minors, the physician’s judgment 
shall prevail as to whether or not the parents should be 
notified of such treatment. 

Multiphasic Screening 

Automated multiphasic health testing and screening 
laboratories are recognized as an extension of services 
available to the physician for the health needs of indi- 
vidual patients. A position statement on multiphasic 
health testing, developed by the ISMS Council on En- 
vironmental and Community Health, and the American 
Medical Association Guidelines for establishing and oper- 
ating such programs are attached as an appendix to the 
Policy Manual. 

Nurses — Shortage 

A severe shortage of graduate nurses continues to im- 
peril the provision of quality patient care. The ISMS sup- 
ports all forms of qualified nursing education and urges 
that all such schools be encouraged to remain in opera- 
tion. 

Nursing Homes 

Every patient receiving long-term nursing care should 
have an attending physician who acknowledges his con- 


for October , 1974 


287 


tinning responsibility in writing. Responsible parties, 
preferably the patient or immediate family, should be 
urged to select a physician. 

Nutrition 

Prophylactic use of iron fortified foods is approved in 
accordance with a 7-point statement developed by the Nu- 
trition Committee and the Council on Environmental and 
Community Health in 1971. 

Occupational Health 

Occupational health is an essential ingredient of em- 
ployee welfare. The adoption and development of health 
programs in industry should be encouraged. 

Occupational health will be advanced through the util- 
ization of industrial physicians. 

Osteopaths, Association with 

Voluntary professional associations with a Doctor of 
Osteopathy are not deemed unethical if the Doctor of 
Osteopathy bases his practice on the same scientific 
principles as those adhered to by members of the Amer- 
ican Medical Association and if he is licensed to practice 
medicine and surgery in all of its branches in Illinois. 

Physician-Patient Relationship 

All committees dealing with the review of physician- 
patient relationship in hospitals and nursing homes are 
urged not to release findings to any third parties except 
by subpoena or court order. Any reports issued by the 
committees involved should be submitted to the chief of 
staff for his disposition. 

Prepayment Plans and Organizations 

It is not within the province of ISMS to act in other 
than an advisory capacity when working with a "third 
party plan,” and its best efforts should be directed to- 
ward supplying guidance, education and communications 
between the membership and the prepayment plans and 
organizations involved. 

The principle of free enterprise as exemplified by pri- 
vate insurance companies and the “Blue” plans is to be 
endorsed. 

Such plans should recognize that free standing medical 
and surgical facilities are acceptable methods of deliver- 
ing high quality health care. Reimbursement for expenses 
incurred as an outpatient in such facilities should be in 
eluded in the benefits of these plans. 

Public Aid 

The "chain of command and procedure” in handling 
problems arising in the field of public aid shall be 
from the county to the state advisory committee; then 
the state advisory committee shall assume the respon- 
sibility of making the medical program work and co- 
operating with the Illinois Department of Public Aid to 
maintain the best type medical care for the recipients 
of state aid. 

The fees paid by the state/federal programs to physi- 
cians shall be based upon the usual and customary fee 
concept. 

An extensive program of education should be con- 
ducted for the recipients of public aid. This should in- 


clude the intelligent handling of all monies provided. 

Rehabilitation of all recipients should be of paramount 
concern. 

Public Health Departments 

Public Health is the art and science of maintaining, 
protecting and improving the health of the people 
through organized community efforts, including contri- 
butions by voluntary health associations, medical societies 
and other health-oriented groups. 

Full-time modern local health departments adequately 
financed and staffed at the county or multiple county level 
are highly desirable and if available, would be capable of 
providing these services to the people throughout the 
state. It is of paramount importance that such depart- 
ments should be established where none now exist and 
that county medical societies, as well as physicians, should 
give their wholehearted support. 

Local public health service jurisdictions should be con- 
solidated into sufficiently large geographic and population 
districts to achieve program efficiency. 

Public Safety 

Motor vehicle operators should be licensed on the basis 
of the applicant’s physical and mental capacity to oper- 
ate such a vehicle safely. 

Rehabilitation 

All physical rehabilitation activities should be prescribed 
by a physician and the treatment carried out under the 
supervision of a physician. 

Medical societies should render assistance to public and 
private agencies regarding rehabilitation facilities to be 
used and in the selection of patients for these services 

Insurance carriers should be encouraged to include re- 
habilitation services in their contracts. 

Relative Value 

The Relative Value Study is not a fee schedule and 
is to be used for information only. All fee payments 
should be based on the usual, customary and reasonable 
concept. 

No co efficient shall be established at the state level. The 
data contained in the study may be used by the ISMS, 
its committees or by any county medical society. 

The study should be revised at appropriate intervals 
upon recommendation of the Relative Value Committee 
with approval of the Board of Trustees. 

Upon request, copies may be furnished third party 
purveyors of health care services. 

Smoking 

The Illinois State Medical Society is opposed to the 
sale of tobacco and tobacco products in hospitals and will 
encourage medical staff action to make hospitals tobacco 
smoke-free. 

Specialty Society Representation 
on ISMS Councils 

For the improvement of communication and the dis- 
cussion of problems of mutual interest and concern, 
closer liaison between specialty societies of medicine and 
the councils of the Board of Trustees is desirable. Repre- 
sentatives to serve in this capacity may be nominated 


288 


Illinois Medical Journal 


by the specialty society, approved by the Board of Trus- 
tees of ISMS, and designated as consultants to the council 
without vote, in compliance with the Bylaws. 

Veterans Administration 

It is our belief that a Veterans Administration hospital 
should admit only those patients with service-connected 
disabilities, except in those instances where the veteran 
is financially unable to pay for his medical care and hos- 
pital services, as shown by a means test. 


ADMINISTRATIVE POLICIES 
AMA-ERF 

The Illinois State Medical Society’s dues billing form 
shall include the names of all medical schools in Illinois 
so that every member may designate which school is to 
receive his AMA-ERF contribution. 

Assessments 

Compulsory assessments of members of hospital staffs 
for any purpose are unethical and improper. 

Autonomy of County Medical Services 

In all areas, the county medical society shall be auto- 
nomous, except that no ruling by any county medical 
society shall conflict with the Principles of Medical Ethics 
of the American Medical Association or with the Constitu- 
tion and Bylaws of the Illinois State Medical Society. 

Birth Certificates 

Birth certificates should contain only such items as are 
pertinent to their function. Information recorded on birth 
certificates should not be provided to organizations or 
individuals for other than approved purposes. 

Budgets— (see “Financial Policies”) 

Committee Appointments 

The chairman of the Board of Trustees and the officers 
of ISMS shall give the trustees an opportunity to recom- 
mend physicians from their districts for appointment to 
various committees. Trustees shall receive the proposed 
list of committee appointments for their consideration and 
review prior to the meeting of the Board at which the 
final committee personnel is to be approved. 

Elective committees should serve for uniform terms of 
office— preferably three years. These terms of office should 
be held on a staggered basis to provide continuity in the 
committee structure. Individual tenure on any committee 
should be limited to a maximum of nine years of con- 
tinuous membership— whether elected or appointed. 

Physicians appointed to an Illinois State Medical So- 
ciety committee must be members in good standing of 
this Society. 

Constitution and Bylaws 

Final copy of any changes made by the House of Del- 
egates in the Constitution and/or the Bylaws shall be 
prepared for publication by the Committee on Constitu- 
tion and Bylaws, in consultation with legal counsel, mak- 


ing sure that the published changes reflect the thinking 
expressed by the action of the House. 

Co-operation with the American 
Medical Association 

Actions of the AMA House of Delegates are binding 
upon its membership at all levels, county, state and na- 
tional. 

(Since all members of the Illinois State Medical Society 
are also members of the American Medical Association, 
this is universally true in Illinois. The right to disagree, 
the right to protest, the right to become "the loyal oppo- 
sition” is not questioned. However, until such time as the 
AMA House has reversed its decision, it is mandatory that 
the membership abide by the will of the majority.) 

Dues, Recommendation of the Board 
to the House 

The chairman of the Board of Trustees shall place the 
question of dues for the coming year on the agenda for 
consideration by the Board of Trustees in time for the 
Board to present its recommendations to the House of 
Delegates each year. 

Immediately following this meeting, written notice of 
the recommendation regarding dues for the next fiscal 
year, shall be mailed to all delegates and alternate dele- 
gates from the component societies, and also to all pres- 
idents and secretaries of county medical societies. This 
recommendation shall also be published in the Illinois 
Medical Journal as a part of the annual report of the 
Chairman of the Board. 

Education, Primary and Secondary 

Primary and secondary education is a community prob- 
lem. In order to retain jurisdiction of these grade schools, 
finances should be raised by taxation at the local level. 

Facility Medical Boards (Physicians) 

In all legislation which establishes boards for the ad- 
ministration of medical facilities operated by governmental 
units, at least one-third of the board should be physicians 
licensed to practice medicine in all its branches. 

Federal Funds 

When a federal government assistance program is es- 
sential it should be conducted under the administration 
and control of local government. The Society does not 
favor any federal assistance program which removes ad- 
ministrative control from the state or local level. 

Financial Policies 

(1) The Finance Committee is to make budgetary 
recommendations to the Board of Trustees. 

(2) The expenses of any duly elected delegate or 
alternate delegate attending the meetings of the House 
of Delegates of the American Medical Association shall 
not be assumed by the ISMS until he enters his official 
term of office set by the Constitution and Bylaws of the 
AMA. 

(3) The expenses of any official representative of the 
ISMS attending any authorized meeting shall be deter- 
mined by the Finance Committee and approved by the 
Board of Trustees. 


for October, 1974 


289 


(4) Any new project authorized by House action re- 
quiring the expenditure of funds must be accompanied 
by an estimate of the cost and suggested methods of pro- 
viding the necessary funds. 

(5) Budgets submitted to the House by the Board 
should provide for the ensuing fiscal year. 

(6) In addition to fixed reserves, the development of a 
contingency reserve is desirable. 

(7) All financial records shall be available at head- 
quarters office, and may be examined by any member of 
the Society. A semi-annual summary of the financial state- 
ments of the Society shall be mailed to any county so- 
ciety secretary or delegate if requested. A projected budget 
for the next fiscal year shall be mailed to the members 
of the House of Delegates at least 30 days prior to the 
annual convention. These reports shall be in the format 
customarily used in ordinary corporate practice. 

House of Delegates, Special Meetings ot 

When a special meeting of the House of Delegates is 
scheduled which may involve an increase in dues or a 
special assessment, the call for that meeting shall contain 
specific notification of that possibility. 

Individual Rights 

Since this Society believes that a strong America is a 
free America, the rights of an individual, or a group of 
individuals, to openly express themselves cannot be con- 
demned even if one is in complete disagreement, if the 
laws of the land are not violated. To support such con- 
demnation would be inconsistent with this Society’s basic 
philosophy. 

Journal Publications 

The Publications (Journal) Committee, with the ap- 
proval of the Board of Trustees, has authority over the 
publication policy and the screening of all advertisers and 
advertising copy appearing in the Illinois Medical Journal. 

Lay Employees’ Functions 

Policy is established by the House of Delegates. 

Staff shall cooperate with officers and committee chair- 
men in setting up activities and in carrying out all nec- 
essary routine. 

Staff also shall keep new officers and committee chair- 
men aware of policy statements, and assist them in the 
preparation of reports to the House of Delegates to: 

change existing policy 

establish new policy 

request House approval of committee projects and/or 

procedure involving policy. 

Committees shall be informed of their right to set up 
operating rules and regulations. 

Legal Counsel 

The legal counsel of the Illinois State Medical Society 
shall concern himself with official inquiries from officers, 
trustees, committee chairmen and county medical societies. 
Such inquiries shall be channeled through the Executive 
Administrator. 

Legislation 

All matters pertaining to state or federal legislation 
shall be referred to the Governmental Affairs Council 


for consideration and recommendation prior to Board 
of Trustees and/or House of Delegates action. 

Matters pertaining to federal legislation shall be 
checked against recommendations or policies of the Amer- 
ican Medical Association lay the Council on Governmental 
Affairs of the Illinois State Medical Society prior to mak- 
ing a recommendation either to the Board of Trustees or 
to the House of Delegates. 

Before any legislation is developed for presentation to 
the Illinois General Assembly, the proposed law shall 
be considered by the Council on Governmental Affairs 
which shall work in close cooperation with any other 
Society committee involved. The instigating committee 
should determine the content of the law and the Gov- 
ernmental Affairs Council primarily should consider re- 
lationship of the proposed legislation to the total legisla- 
tive program. 

Any Council or Committee recommending legislation 
to the attention of the Governmental Affairs Council 
must provide expert witnesses when called upon to test- 
ify before Senate and House Committees in support of, 
or in opposition to, the legislation recommended by the 
Council or Committee. 

Legislative Intrusion into Medical Judgment 

The Illinois State Medical Society opposes any and all 
legislative efforts to interfere with physicians’ judgment 
as to which procedures are appropriate and in the best 
interest of his or her patients and ISMS will work aggres- 
sively to oppose any legislation abridging the physician’s 
prerogatives in this regard. 

Mailing List 

The use of the mailing list of ISMS members must be 
approved by special action of the Board of Trustees. 

Medical Representation in 
Government Planning 

In health programs financed by government funding in 
an Illinois community, there shall be representation at 
the highest policy level by an official representative of 
the State Society and the appropriate county medical 
society involved. Remuneration for services in above pro- 
grams shall follow the policies of the Illinois State Medical 
Society. 

Only those programs which have involved physicians 
at the local level in the planning and development stages 
shall be approved by ISMS. 

Membership in Paramedical and 
Service Organizations 

Membership in Chambers of Commerce (city, state and 
national) is to be encouraged. This policy extends to the 
individual physician as well as to the component societies. 

The Society recommends that physicians affiliate with 
service clubs, local political action groups and participate 
to the fullest extent possible in affairs affecting the 
health and welfare of the residents of Illinois. 

Membership of Osteopathic Physicians 
in ISMS 

Osteopathic physicians who meet all qualifications for 
membership, base their practice on the same scientific 
principles as those adhered to by members of the AMA, 


290 


Illinois Medical Journal 


and are licensed to practice medicine in all its branches 
in Illinois, may be accepted as active members by the 
county medical societies throughout the state, and be ac- 
corded all privileges of full membership at the county 
and state levels and be so reported to the American Med- 
ical Association for acceptance at that level. 

Placement Service 

Before the Physicians’ Placement Service recommends 
that a town in Illinois be listed as needing a physician, it 
shall be established that the need actually exists; that 
the community can support a physician; that certain 
physicial assets (office— home— schools, etc.) are available 
for the physician and his family. 

The qualifications of the physician also shall be ascer- 
tained prior to furnishing him with the list of available 
areas in Illinois needing a physician. 

Policy Statements 

Policy statements shall be defined as guide lines for 
the management of the Illinois State Medical Society af- 
fairs, based upon prudence, sound judgment and exper- 
ience. 

Rules and regulations may be prepared by the Board of 
Trustees or by committees, for use in the implementation 
of policy. 

Polls, Opinion 

The vote of the House of Delegates shall express the 
opinion of the majority of the Illinois State Medical So- 
ciety membership. Since delegates are the duly elected rep- 
representatives of their county medical societies and their 
voting reflects the thinking of their constituents, a ma- 
jority opinion has been expressed, and a membership 
poll becomes unnecessary except under very exceptional 
conditions. 

Press 

All county medical societies should be encouraged to 
cooperate with the local press. The public should be pro- 
vided with prompt and accurate information in all health 
fields; the source of this information should be the medi- 
cal profession. 

County medical societies should provide information 
at the local level; the State Society is responsible for press 
releases involving State Society officers or any official 
statements of the Society appearing in the press. 

A code of ethics applicable to medicine and the fourth 
estate should be developed. (That used in the Decatur 
area has been given national recognition by the AMA.) 

Publication of Research Data 

In releasing research material for publication in the 
Illinois Medical Journal, or any other media, extreme care 
should be exercised. The welfare and privacy of the pa- 
tient, the professional reputation of the physician should 
be of primary concern. 

If any question arises, consultation with the Board ol 
Trustees is suggested. All such inquiries should be ad 
dressed to its chairman. 


Public Affairs 

No officer or member of the Board of Trustees should 
be permitted (during his term of office) to allow his name 
as an officer or a member of the Board to be used in 
lists endorsing candidates for public office. Naturally his 
right to this privilege as a private individual is not 
affected. 

Rebates 

In conformity with the AMA Principles of Ethics, 
rebates of any nature to any member, county or regional 
medical society, are unethical. This statement on rebates 
was developed as a result of a letter regarding collection 
services. It read in part: 

“It is our policy to remit to a participating association 
the sum of 10 per cent of the gross boon sales to its 
members in addition to 10 per cent of the gross com- 
missions received from collections. A report and ac- 
companying payment is submitted monthly from our 
office.” 

Reference Committee Appointments 

Whenever possible at least two members shall be re- 
tained on all reference committees for the following 
year in order to effect continuity of experience. 

Reference Service 

Physician reference service shall be the responsibility 
of the county medical society. When any such request 
is received at the state society office or by any officer of 
the ISMS, it shall immediately be referred to the secre- 
tary of the county medical society involved. 

Stationery, Use of Official 

No officer, trustee, committee chairman or staff director 
is to use the official stationery of the Illinois State Medical 
Society for personal statements of any nature. This shall 
pertain especially to the endorsement of any candidate 
for public office. 

Surveys 

The Illinois State Medical Society endorses the prin- 
ciple of mass surveys and encourages the use of this 
method whenever it meets with the approval of the 
local county medical society. 

Any new state program involving more than one county 
society should be submitted to the Board of Trustees 
for initial approval. 

Uniform Healtli Insurance Claim Form 

The Illinois State Medical Society supports the use of 
the Health Insurance Claim Form developed by the AMA 
Council on Medical Service by all insurance carriers and 
physicians. 

Woman’s Auxiliary 

Projects in which the Auxiliary participates shall be 
approved by the local county medical society. 

Requests for cooperation between the Auxiliary and the 
Illinois State Medical Society should be channeled through 
the Advisory Committee provided by the Board of 
Trustees. 


for October, 1974 


291 


APPENDIX 


Multiphasic Health Testing 
Council on Environmental and 
Community Health Statement 


During the recent past there has been an upwelling of 
various automated or multiphasic health testing or screen- 
ing programs. The use of the results of such testing has 
at times led to a false sense of security on the part of 
patients, whereas other programs are being foisted on 
the public with the view to making money with very 
little concern for an individual’s well being. Other pro- 
grams are offered as having direct, immediate and prac- 
tical medical value, without review by a physician. These 
many concerns prompt the necessity of a position state- 
ment on the use and application of such programs. 

There is a place for computer and automated multi- 
phasic testing and screening programs as an extension 
of the services available to the physician as he considers 
each individual case. It is entirely possible that such a 
mechanism will enable a physician to expand his scope 
of operation. 

Forms of automated multiphasic health testing have 
been used by public health agencies and centers for de- 
velopmental research in epidemiology. In these programs, 
asymptomic control patients have been tested. Testings 
have been done to establish medical priorities or case 
findings in communities. Other testing has been done to 
separate those who probably have certain characteristics 
from those who do not. 

Occupational or industrial health programs have used 
testing programs for the betterment of employees’ health 
and working conditions. Programs such as these, whether 
a pre-employment examination or a study to control 
health hazards, are not necessarily related to medical 
care as such. The physician in charge may or may not 
at the same time be the attending physician of the 
employee. 

As far as automated multiphasic health testing programs 
for individuals are concerned, these programs obtain 
health-related data and act as data collecting sources, 
following a routine using technicians or mechanical and 
electronic devices to determine facts. In several hours a 
variety of tests and measurements can be made which 
may provide a profile of an individual’s physical status. 
Such a profile can be of value to a physician. The testing 
is not diagnosis or interpretation. 


Some individually oriented automated multiphasic 
health testing programs are operated commercially on 
a for-profit basis. Many of these do determine and report 
facts accurately. Some, however, give the appearance of 
encouraging individuals to be tested without a medical 
referral for the tests. Some indicate that when the results 
are compared against standards or norms the individual 
does not even have to see a physician. Some, in addition, 
perform a battery of tests which are not requested by 
an attending physician. 

The physician’s ethical responsibility is to provide his 
patient with high quality services. He should not utilize 
services of any testing program unless he has the utmost 
confidence in the quality of its services. He must assume 
professional responsibility for the best interest of the 
patient. As a professional man, the physician is entitled 
to compensation for his services. However, he should 
not be engaged in the commercial conduct of a testing 
or screening program and should not make a mark up 
commission or profit on services rendered by others. It 
is not, in itself, unethical for a physician to own an 
automated multiphasic facility or interest. The use the 
physician makes of this ownership may be unethical. 

An attending physician may not receive a rebate, re- 
ferral fee, or commission from a program whose facili- 
ties have been used by his patients. 

An automated health testing facility is a fact finding 
and reporting system. It must be limited to fact finding 
and exclude interpretation. Findings disclosed must be 
interpreted only by physicians. 

Offering a combination or medical and non-medical 
service to the public is to be avoided. The public may 
be confused as to what constitutes reporting a fact and 
what constitutes the making of a medical diagnosis. 

A practicing physician may recommend multiphasic 
health testing where he believes it may be helpful to 
him in the care of his patient. Prudence dictates that 
the physician be selective in recommending or requiring 
patients to utilize the services of an automatic health 
testing facility and not adopt the practice of routinely 
requiring that all patients, or all new patients, undergo 
such testing. When good medical judgment suggests the 


292 


Illinois Medical Journal 


desirability of such testing, the physician should explain 
in general the nature and purpose of the testing. The 
patient must be afforded freedom to choose between 
automated multiphasic health testing facilities, if avail- 
able. Alternatives in the way of single tests should be 
offered patients, where possible and practical. 

An individual who is tested, or a facility which con- 
ducts these tests, may neither demand that a physician 
accept an individual as a patient nor evaluate the tests 
for the individual. The physician remains free to choose 
whom he will serve. 

A physician employed by an automated multiphasic 
health testing facility, in conformity with well established 
policies, should not dispose of his professional attain- 
ments to any corporation or to a lay body under terms 
or conditions which permit the sale of the services of 
that physician by an agency for fee, nor allow his name 
or the prestige of his professional status as a physician 
to be used in the promotion of a commercial enterprise. 
He should neither aid nor abet an unlicensed individual 
or corporation to practice medicine. 

There is a responsibility for the medical society to 
educate the public regarding indications for and against 
multiphasic health testing, to educate the membership 
of the society regarding ethical responsibilities in these 


matters, and the society must be ready to assist persons 
or corporations that seek advice in setting up multi- 
phasic health testing facilities. 

An individual who is tested, or a facility which con- 
ducts these tests, may neither demand that a physician 
accept an individual as a patient nor evaluate the tests 
for the individual. The physician remains free to choose 
whom he will serve. 

A physician employed by an automated multiphasic 
health testing facility, in conformity with well established 
policies, should not dispose of his professional attainments 
to any corporation or to a lay body under terms or con- 
ditions which permit the sale of the servcies of that 
physician by an agency for fee, nor allow his name 
or the prestige of his professional status as a physician 
to be used in the promotion of a commercial enter- 
prise. He should neither aid nor abet an unlicensed in- 
dividual or corporation to practice medicine. 

There is a responsibility for the medical society to edu- 
cate the public regarding indications for and against 
multiphasic health testing, to educate the membership 
of the society regarding ethical responsibilities in these 
matters, and the society must be ready to assist persons 
or corporations that seek advice in setting up multiphasic 
health testing facilities. 


AMA Guidelines for Establishing and Operating 
Multiphasic Health Testing Programs 


The following guidelines are recommended for use by 
physicians and medical societies in providing technical 
advice and assistance in the planning, development, im- 
plementation, and operation of multiphasic health test- 
ing programs: 

1. Multiphasic health testing is a method of acquiring, 
storing, collating, and reproducing medical data on 
individual patients. The testing procedures are con- 
sidered to be incomplete health services. Provisions 
must be made for a physician to interpret and evalu- 
ate this medical data base as an aid in continuing 
patient care. 

2. The multiphasic testing program should meet applic- 
able licensing requirements and be appropriately 
evaluated for quality control. 

3. Physicians should be involved in the planning and 
development of testing programs, and the operation 
of all programs should be supervised by qualified 
physicians. 

4. The system should be designed to make maximum 
use of allied health professionals and should utilize 
technical and automated techniques where justified. 

5. For professional value and economic feasibility, the 
program should include tests that are simple, safe, 
easy to interpret, inexpensive and quick to perform, 
and that have acceptable sensitivity, specificity, high 
predictive value, and patient acceptance. 


6. The testing system should include the following cri- 
teria: reliability, accuracy of output, saving of time 
of physicians and allied health personnel, adequate 
utilization, and sufficient flexibility for customization 
to physician and patient needs. The program should 
establish individual ethnic, geographic, and other 
variations of normal and abnormal patterns. 

7. The program should provide for confidentiality of 
patient data. 

8. The testing program should be used, where feasible, 
to meet otherwise unmet community health needs 
and should be integrated into the continuing health 
care system. 

9. The testing program should be designed to meet 
various objectives such as diagnostic services, health 
maintenance, and guidance in management of on- 
going illness including chronic disease. 

10. Evaluation methodology should be built into the 
program to determine the acceptance and use, yield, 
false positives and false negatives, as well as the long- 
term effects of the program on illness and the need 
and demand for health services. The program should 
include a documented accounting system, at least for 
internal use, and a reasonable cost finding system 
that would allow for cost analysis and cost summaries. 

11. The program should maintain freedom of choice for 
both the physician and the patient. 


for October, 1974 


293 


ISMS House of Delegates 

OFFICIAL MEMBERS OF THE HOUSE WITH THE RIGHT TO VOTE 


Officers of ISMS 

President— Fredric D. Lake 

1041 Michigan Ave., Evanston 60202 
President-elect— J. M. Ingalls 
502 Shaw Ave., Paris 61944 
Secretary-Treasurer— Jacob E. Reisch 
1129 S. 2nd St., Springfield 62704 
First Vice President— Harold A. Sofield 
715 Lake St., Oak Park 60301 
Second Vice President— Robert R. Hartman 
1515A Walnut St., Jacksonville 62650 
Speaker of the House— Andrew J. Brislen 
6060 S. Drexel Blvd., Chicago 60637 
Vice Speaker of the House— James A. McDonald 
13 S. 2nd St., Geneva 60134 

Board of Trustees 

Chairman, Board of Trustees— Joseph L. Bordenave 


1665 South St., Geneva 60134 

1st District— Joseph L. Bordenave 1977 

1665 South St., Geneva 60134 

2nd District— Allan L. Goslin 1977 

712 N. Bloomington, Streator 61364 

3rd District— David S. Fox 1976 

20829 Green Center Court, 

Olympia Fields 60461 

Robert T. Fox 1976 

2136 Robin Crest Lane, Glenview 60025 

Eugene T. Hoban 1975 

6429 North Ave., Oak Park 60302 

Joseph Skom 1975 

707 Fairbanks, Chicago 60611 


William M. Lees 1977 

6518 N. Nokomis, Lincolnwood 60646 

George C. Shropshear 1977 

1525 E. 53rd, Chicago 60615 

Philip G. Thomsen 1977 

13826 Lincoln, Dolton 60419 

Frederick E. Weiss 1976 

15643 Lincoln, Harvey 60426 

Warren W. Young 1975 

3450 Haweswood Dr., Crete 60417 

4th District— Fred Z. White 1976 

723 N. 2nd St., Chillicothe 61523 

5th District— A. Edward Livingston 1976 

219 N. Main, Bloomington 61701 

6th District— Mather Pfeiffenberger 1975 

State & Wall Streets, Alton 62002 

7th District— Arthur F. Goodyear 1976 

142 E. Prairie Ave., Decatur 62523 

8th District— Eugene P. Johnson 1976 

P.O. Box 68, Casey, 62420 

9th District— Warren D. Tuttle 1975 

203 N. Vine, Harrisburg 62946 

10th District— Herbert Dexheimer 1975 

301 S. Illinois, Belleville 62220 

11th District— Ross Hutchison 1977 

126 E. Ninth St., Gibson City 60936 
Trustee at Large— Willard C. Scrivner 1975 


Suite 2, 6600 W. Main, Belleville 62223 

Representatives of County Societies 

A complete listing of delegates and alternates to the 
ISMS House will appear with the convention program. 


EX-OFFICIO MEMBERS OF THE HOUSE WITHOUT THE RIGHT TO VOTE 


Past Presidents 

J. Ernest Breed 1971 

Everett P. Coleman 1945-1946 

Edward W. Cannady 1970 

Newton DuPuy 1968 

Harlan English 1964 

Edwin S. Hamilton 1962 

H. Close Hesseltine 1961 

Charles J. Jannings, III 1972 

Frank J. Jirka, Jr 1973 

Willis 1. Lewis 1954 

George F. Lull 1963 

Burtis E. Montgomery 1966 

Edward A. Piszczek 1965 

Caesar Portes 1967 

Willard C. Scrivner 1974 

Leo P. A. Sweeney 1953 

Philip G. Thomsen 1969 

Arkell M. Vaughn 1955 


Past Trustees 

Earl H. Blair 

Chicago, Trustee of the 3rd District 
Walter C. Bomemeier 
Chicago, Trustee of the 3rd District 
Carl E. Clark 

Sycamore, Trustee of the 1st District 
Willard W. Fullerton 
Sparta, Trustee of the 10th District 


George E. Griffin 

Princeton, Trustee of the 2nd District 
Lee N. Hamm 

Lincoln, Trustee of the 5th District 
George A. Hellmuth 

Chicago, Trustee of the 3rd District 
Bernard Klein 

Joliet, Trustee of the 11th District 
Ted LeBoy 

Chicago, Trustee of the 3rd District 
Warner H. Newcomb 

Jacksonville, Trustee of the 6th District 
Joseph R. O’Donnell 

Glen Ellyn, Trustee of the 11th District 
Ralph N. Redmond 
Sterling, Trustee from the 2nd District 
Paul P. Youngberg 
Moline, Trustee of the 4th District 
Darrell H. Trumpe 

Springfield, Trustee of the 5th District 
William H. Schowengerdt 

Champaign, Trustee of the 8th District 
Charles K. Wells 

Mt. Vernon, Trustee of the 9th District 


Past Speakers 

Walter C. Bornemeier, Chicago 1961-1964 

Edward W. Cannady, Belleville 1964-1967 

Maurice M. Hoeltgen, Chicago 1967-1970 

Paul W. Sunderland, Gibson City 1970-1973 


294 


Illinois Medical Journal 


AMA DELEGATION 

Delegates to the American Medical Association 


To Serve From Jan. 1, 1973 to Dec. 31, 1971 
(elected March 10, 1972 ) 

Carl E. Clark 

225 Edward St., Sycamore 60178 
H. Close Hesseltine 
5807 South Dorchester, Chicago 60637 
Maurice M. Hoeltgen 
4700 W. 95th St., Oak Lawn 60453 
William M. Lees 

6518 North Nokomis, Lincolnwood 60646 
Theodore R. Van Dellen 
435 North Michigan Ave., Chicago 60611 
Charles K. Wells 

117 North 10th St., Mt. Vernon 62864 

To Serve From Jan. 1, 1974 to Dec. 31, 1975 
(elected March 28, 1973) 

Jack Gibbs 

175 South Main St., Canton 61520 
Theodore Grevas 

1800 Third Ave., Rock Island 61201 
Frank J. Jirka, Jr. 

1507 Keystone Ave., River Forest 60305 
Morgan M. Meyer 

573 South Lombard, Lombard 60148 
Edward A. Piszczek 

6410 North Leona, Chicago 60646 
Philip G. Thomsen 

13826 Lincoln, Dolton 60419 


To Serve From Jan. 1, 1975, to Dec. 31, 1976 
(elected April 6, 1971) 

Carl E. Clark 

225 Edward St., Sycamore 60178 
Alfred J. Faber 

2110 Swainwood Dr., Glenview 60025 
H. Close Hesseltine 
5807 S. Dorchester, Chicago 60637 
Maurice M. Hoeltgen 
4700 W. 95th St., Oak Lawn 60453 
William M. Lees 

6518 N. Nokomis, Lincolnwood 60646 
Charles K. Wells 

117 N. 10th St., Mt. Vernon 62864 


Honorary Delegates 

Walter C. Bornemeier 

19273 Harleigh Dr., Sartago, Calif. 95070 
Edwin S. Hamilton 
985 Cobb Street, Kankakee 60901 
George F. Lull 

2440 Lakeview Avenue, Chicago 60614 
Burtis E. Montgomery 

37 South Main Street, Harrisburg 62946 


Alternate Delegates to the American Medical Association 


To Serve From Ja?i. 1, 1973 to Dec. 31, 1974 
(elected March 10, 1972) 

Alfred J. Faber 

2110 Swainwood Dr., Glenview 60025 
Frank J. Jirka, Jr. 1 

1507 Keystone Ave., River Forest 60305 
Fredric D. Lake 2 

2520 North Lakeview, Chicago 60614 
Eugene T. Leonard 

1215 North Alpine, Rockford 61107 
John Ring 

511 East Hawley St., Mundelein 60060 
Fred A. Tworoger 
4753 Broadway, Chicago 60640 

To Serve From Jan. 1, 1971 to Dec. 31, 1975 
(elected March 28, 1973) 

Herschel Browns 

4600 North Ravenswood Ave., Chicago 60640 
Allison L. Burdick, Jr. 

10 West Ontario, Oak Park 60302 
Jerry M. Ingalls 

Medical Center, Paris 61944 
Joseph R. O’Donnell 

444 Park Ave., Glen Ellyn 60137 


George Shropslrear 

1525 East 53rd St., Chicago 60615 
Paul W. Sunderland 

214 North Sangamon, Gibson City 60936 
Glen Tomlinson 

1825 West Harrison St., Chicago 60612 

To Serve From Jan. 1, 1975, to Dec. 31, 1976 
(elected April 6, 1974) 

Fredric D. Lake 

2520 N. Lakeview, Chicago 60614 
Eugene T. Leonard 

1215 N. Alpine, Rockford 61107 
John Ring 

511 E. Hawley St., Mundelein 60060 
Fred A. Tworoger 
4753 Broadway, Chicago 60640 
Theodore R. Van Dellen 
435 N. Michigan Ave., Chicago 60611 

1 Elected to Delegate position March 28, 1973, effective 
Jan. 1, 1971 

2 Elected to fill unexpired term of Frank J. Jirka, Jr. 


for October, 1971 


295 


Officers of County Medical Societies 

1974 


County 

Adams 

Members: 86-Dist. No. 6 
Alexander 

Members: G-Dist. No. 10 
Bond 

Members: 8-Dist. No. 7 
Boone 

Members: 14-Dist. No. 1 
Bureau 

Members: 22-Dist. No. 2 
Carroll 

Members: 9-Dist. No. 1 

Cass-Brown 

Members: 6-Dist. No. 6 

Champaign 

Members: 209-Dist. No. 8 
Larry Booth, Exec. Sec. 
407 S. 4th St. 

Champaign 61820 

Christian 

Members: 1 9-Dist. No. 7 
Clark 

Members: 6-Dist. No. 8 
Clay 

Members: 6-Dist. No. 7 
Clinton 

Members: 14-Dist. No. 7 

Coles-Cumberland 

Members: 37-Dist. No. 8 

Crawford 

Members: 13-Dist. No. 8 
Dr. Kalb 

Members: 55-Dist. No. 1 
De Witt 

Members: 10-Dist. No. 5 
Douglas 

Members: 9-Dist. No. 8 
Du Pace 

Members: 468-Dist. No. 1 1 
Lillian Widmer, Exec. Sec. 
646 Roosevelt Rd. 

Glen Ellyn 60137 

Edgar 

Members: 16-Dist. No. 8 
Edwards 

Members: 2-Dist. No. 9 
Effingham 

Members: 20-Dist. No. 7 


President 

George H. Eversman 

1415 Vermont, Quincy 62301 

Gemo Wong 

2020 Cedar St., Cario 62914 

James R. Goggin 

207 N. 2nd St., Greenville 62246 

M. Joseph Carlisle 

115 W. Lincoln, Belvidere 61108 

Kent Monroe 

207 E. St. Paul, Spring Valley 61362 
C. G. Piper 

203 W. Market, Mt. Carroll 61053 
R. A. Spencer 

115 W. 4th St., Beardstown 62618 
Stanley Smith 

Carle Clinic, Urbana 61801 


R. B. Siegert 

217 S. Locust, Pana 62557 

Howard G. Johnson 
Casey Medical Center, Casey 62420 

A. Paul Naney 
Flora Clinic, Flora 62839 

M. B. Floreza 

118 N. Oak, Trenton 62293 
Guy Harper 

904 Third, Charleston 61920 
M. D. Miodus 

Oblong Clinic, Oblong 62449 
H. Logan Fisher 

1838 Sycamore Rd., De Kalb 60115 

John W. Veirs 
219 E. Main, Clinton 61727 

Humberto Mondul 

100 W. Sale, Tuscola 61953 

Robert D. Dooley 

5101 Willow Springs, LaGrange 60525 


Charles Salesman 

Box 426, Paris 61944 

Paul S. Neirenbcrg 
7 W. Main, Albion 62806 

H. E. Morales 

300 N. Maple, Effingham 62401 


Secretary 

Julio del Castillo 

111. St. Bank Bldg., Quincy 62301 

Charles L. Yarbrough 

800 Commercial, Cairo 62914 

M. Kenneth Kaufmann 

105 E. College, Greenville 62246 

Earl S. Davis 

119 S. State, Belvidere 61108 


Eliseo M. Colli 

102 E. Washington, Mt. Carroll 61053 
B. A. DeSulis 

115 W. 4th St., Beardstown 62618 
H. Ewing Wacliter 

1609 W. Springfield, Champaign 61820 


[. W. Murphy 

301 S. Webster, Taylorville 62568 

James R. Buechler 

P.O. Box 219, Marshall 62441 

Donald L. Bunnell 

Flora Clinic, Flora 62839 

E. H. Ketterer 

289 N. Main, Breese 62230 

J. D. Heath 

6 Orchard Dr., Charleston 61920 
W. B. Schmidt 

408 S. Cross, Robinson 62454 

William Deschler 

225 Edwards, Sycamore 60178 

Charles A. Ramey 
215 E. Main, Clinton 61727 

Elmer S. Allen 

120 S. Locust, Areola 61910 

James P. Campbell 
322 N. Blanchard, Wheaton 60187 


J. M. Ingalls 

502 Shaw Ave., Paris 61944 

Andrew Krajec 

Box 336, West Salem 62476 

L. Beis 

702 W. Kentucky, Effingham 62401 


296 


Illinois Medical Journal 


County 


President 


Secretary 


Fayette 

Members: 10-Dist. No. 7 
Ford 

Members: 8-Dist. No. 11 
Franklin 

Members: 22-Dist. No. 9 
F ULTON 

Members: 29-Dist. No. 4 
Gallatin 

Members: 1-Dist. No. 6 
Greene 

Members: 6-Dist. No. 6 
FIancock 

Members: 9-Dist. No. 4 
FIenderson 

Members: 1 -Dist. No. 4 

Henry-Stark 
Members: 31-Dist. No. 4 

Iroquois 

Members: 18 Dist. No. 11 
Jackson 

Members: 63-Dist. No. 10 
Jasper 

Members: 2-Dist. No. 8 

Jefferson-Hamilton 
Members: 36-Dist. No. 9 

Jersey-Calhoun 

Members: 11 -Dist. No. 6 

Jo Daviess 

Members: 8-Dist. No. 1 
Kane 

Members: 274-Dist. No. 1 
Michael Wild, Exec. Dir. 
214 W. State St. 

Geneva 60134 

Kankakee 

Members: 91 -Dist. No. 11 
Kendall 

Members: 7-Dist. No. 11 
Knox 

Members: 63-Dist. No. 4 
Lake 

Members: 280-Dist. No. 1 
Julia Schulz, Exec. Sec. 
P.O. Box 148 
Gurnee 60031 

La Salle 

Members: 97-Dist. No. 2 
Lawrence 

Members: 10-Dist. No. 8 
Ruth Gariepy, Exec. Sec. 
Lawrence City Mem. Hosp. 
Lawrenceville 62439 


D. H. Rames 

1029 N. 8th, Vandalia 62471 

William A. Garrett 
Sibley 61773 

Loren L. Love 

6 Hillcrest Dr., Christopher 62822 

Robert W. Ridley 

Coleman Clinic, Canton 61520 


Gary L. Turpin 

712 S. College, Greenfield 62044 

Werner Schoenherr 
Bowen 62316 


Luis J. Garcia 

719 Elliott, Kewanee 61443 

S. D. Roeder 

845 S. 4th St., Watseka 60970 
Allan Bennett 

P.O. Box 2347, Carbondale 62901 

Don L. Hartrich 

1211 W. Jourdan, Newton 62448 

Kelly M. Berkley 

Doctors Pk. Rd., Mt. Vernon 62864 

Bernard Baalman 

Medical Center, Hardin 62047 

Wilbur E. Johnson 
Galena 61036 

James E. Habegger 

32 S. Lincoln, Geneva 60134 


Preston W. Sawyer 
70 Meadowview Ct., Kankakee 60901 

Victor Smith 
Newark 60541 

Kent Kleinkauf 

632 Bondi Bldg., Galesburg 61401 

Lionel W. Ganshirt 

1140 Ash Lawn Dr., Lake Forest 60045 


Robert Lewis 

628 Columbus, Ottawa 61350 
R. T. Kirkwood 

Kensler Bldg., Lawrenceville 62439 


E. A. Kuehn 

501 W. Gallatin. Vandalia 62471 

Paul W. Sunderland 
214 N. Sangamon, Gibson City 60936 

D. P. Richerson 

P.O. Box 99, Christopher 62822 

Marvin E. Schmidt 
210 W. Walnut, Canton 61520 

John E. Doyle 
Ridgway 62979 

James C. Reid 

Pillager Mem. Clinic, Greenfield 62044 

James E. Coeur 

630 Locust, Carthage 62321 

Silvino Lindo, Jr. 

Biggsville 61448 

David E. Stearns 
513 Elliott, Kewanee 61443 

Dale Learned 

219 N. Central, Gilman 60938 
Paul Lorenz 

P.O. Box 2347, Carbondale 62901 
Monico Low 

309 S. Van Buren, Newton 62448 
Antonio Boba 

P.O. Box 643, Mt. Vernon 62864 
Clyde Wieland 

Maple Summit Rd., Jerseyville 62052 

Lyle A. Rachuy 

323 N. Main, Stockton 61085 

James C. Pritchard 

1725 S. St., Geneva 60134 


A. A. Palow 

555 S. Schuyler, Kankakee 60901 

John P. Cullinan 
Oswego 60543 

Juan Espejo 

695 N. Kellogg, Galesburg 61401 
George A. Olander 

1950 Sheridan Rd., Highland Park 60035 


Allan L. Goslin 

712 N. Bloomington, Streator 61364 

Larry D. Herron 

N. Main St., Bridgeport 62417 


for October, 1971 


297 


County 


President 


Secretary 


I.ee 

Members: 20-Dist. No. 2 
Livingston 

Members: 29-Dist. No. 2 
Logan 

Members: 20-Dist. No. 5 
Macon 

Members: 143-Dist. No. 7 
Mary J. Bretz, Exec. Sec. 
1800 E. Lake Shore Dr. 
Decatur 62521 

Macoupin 

Members: 20-Dist. No. 6 
Madison 

Members: 142-Dist. No. 6 
Marion 

Members: 39-Dist. No. 7 
Mason 

Members: 5-Dist. No. 5 
Massac 

Members: 3-Dist. No. 9 

McDonouch 
Members: 27-Dist. No. 4 

McHenry 

Members: 67-Dist. No. 1 
Evelyn Rosulek, Exec. Sec. 
308 E. Kimball 
Woodstock 60098 

McLean 

Members: 92-Dist. No. 5 
Cathy Sengpiel, Exec. Sec. 
401 W. Virginia 
Normal 61761 

Menard 

Members: 1-Dist. No. 5 
Mercer 

Members: 4-Dist. No. 4 
Monroe 

Members: 9-Dist. No. 10 

Montgomery 

Members: 15-Dist. No. 5 

Morgan-Scott 

Members: 39-Dist. No. 6 

Moultrie 

Members: 5-Dist. No. 7 
Ogle 

Members: 15-Dist. No. 1 
Peoria 

Members: 264-Dist. No. 4 
David W. Meister, Jr. 
Exec. Sec. 

427 1st Nat. Bk. Bldg. 
Peoria 61602 


Howard Edwards 

144 N. Court, Dixon 61021 

Thomas Minoque 

Fairbury Med. Assoc., Fairbury 61739 
H. R. Rivero 

914 E. Broadway, Lincoln 62656 
A. J. Kiessel 

1800 E. Lake Shore, Decatur 62521 


Robert England 
403 E. First, Carlinville 62626 

Alan Skirball 

2044 Madison, Granite City 62040 

Samuel S. Rosenblum 

310 E. Noleman, Centralia 62801 

Dario Landazuri 

125 N. Orange, Havana 62644 

James L. Bremer 

805 Market, Metropolis 62960 

Joseph I.. Symmonds 

301 E. Jefferson, Macomb 61455 

Vincenzo B. Petralia 
445 Park, Cary 60013 


Lobert G. Killough 
401 W. Virginia, Normal 61761 


Robert J. Schafer 

116 N. 5th, Petersburg 62675 

R. N. Svendsen 

209 S. College, Aledo 61931 

I. Kremer 
Columbia 62236 

L. George Allen 
400 N. Monroe, Litchfield 62056 

A. M. Paisley 

209 W. State, Jacksonville 62650 
Phillip Best 

14 N. Washington, Sullivan 61951 


L. T. Koritz 

324 Lincoln, Rochelle 61068 

Willard M. Easton 
427 1st Nat. Bk. Bldg., Peoria 61602 


William McNichols 

101 W. 1st St., Dixon 61021 

Karl T. Deterding 
612 E. Water St., Pontiac 61764 

Toby E. Silverstein 

311 8th St., Lincoln 62656 

William C. Simon 

1807 N. Edward St., Decatur 62521 


Lee Johnson 

703 N. Easton, Staunton 62088 

Norman E. Taylor 
95 S. 9th St.,' E. Alton 62024 

Walter P. Plassman 

Box 552, Centralia 62801 

Henry W. Maxfield 
Mason City 62664 

Ralph K. Frazier 

Hospital Dr., Metropolis 62960 

Stephen I,. Roth 
Box 258, Colchester 62326 

Aniceto M. D’Sousa 

1110 N. Green, McHenry 60050 


Douglas R. Bey 
401 W. Virginia, Normal 61761 


Robert J. Schafer 

116 N. 5th St., Petersburg 62675 

Monty P. McClellan 
309 NW 2nd St., Aledo 61231 

Edelberto Maglasang 

109 W. Legion St., Columbia 62236 

James T. Foster 

8 Arrowhead Rd., Litchfield 62056 
R. H. Kooiker 

1600 W. Walnut, Jacksonville 62650 

Dean McLaughlin 

112 E. Harrison, Sullivan 61951 

Russell Zack 

915 Caron Rd., Rochelle 61068 
Gene O. Hoerr 

427 1st Nat. Bk. Bldg., Peoria 61602 


298 


Illinois Medical Journal, 


County 


President 


Secretary 


Perry 

Members: 16-Dist. No. 10 

W. M. Thornburg 

Medical Group Bldg., DuQuoin 62832 

Piatt 

Members: 6-Dist. No. 7 

George Green 

121 N. State St., Monticello 61586 

Pike 

Members: 9-Dist. No. 6 

Warren C. Barrow 

321 W. Washington, Pittsfield 62363 

Pulaski 

Members: 1-Dist. No. 10 

A. L. Robinson 

Box 277, Mounds 62964 

Randolph 

Members: 1 9-Dist . No. 10 

L. C. Fiene 

W. Belmont St., Sparta 62286 

Richland 

Members: 23-Dist. No. 8 

Willard J. Eyer 

119 Market St., Olney 62450 

Rock Island 

Members: 164-Dist. No. 4 
James Koch, Exec. Sec . 
612 Kahl Bldg. 
Davenport, Iowa 52801 

N. T. Braatelein 
635 10th Ave., Moline 61265 

Sr. Clair 

Members: 209-Dist. No 10 
Ed Belz, Exec Sec. 

4825 W. Main St. 
Belleville 62223 

Theodore L. Bryan 

3120 State St., E. St. Louis 62205 

Saline- Pope- Hardin 

Members: 26-Dist. No. 9 

Gary 1). Cody 

1201 Pine St., Eldorado 62930 

Sangamon 

Members: 252-Dist. No. 5 
E. R. Brosi, Exec. Sec. 
2100 Lindsay Rd. 
Springfield 62704 

Donald H. Yurdin 

1000 S. 6th St., Springfield 62702 

Schuyler 

Members: 3-Dist. No. 4 

R. R. Dohner 

103 W. Washington, Rushville 62681 

Shelby 

Members: 6-Dist. No. 7 

Duncan Biddlecombe 

805 N.W. Sixth, Shelbyville 62565 

Stephenson 

Members: 47-Dist. No. 1 

Erich Awender 

1717 W. Church, Freeport 61032 

Tazewell 

Members: 45-Dist. No. 5 
David W. Meister, Jr. 
Exec. Sec. 

427 1st Nat. Bk. Bldg. 
Peoria 61602 

Theofan R. Trifonoff 

427 1st Nat. Bk. Bldg., Peoria 61602 

Union 

Members: 6-Dist. No. 10 

Robert L. Rader 
200 N. Main St., Anna 62906 

Vermilion 

Members: 86-Dist. No. 8 

Grover L. Seitzinger 
812 N. Logan, Danville 61832 

Wabash 

Members: 7-Dist. No. 9 

Roger Fuller 

1132 Chestnut, Mt. Carmel 62863 

W ARREN 

Members: 10-Dist. No. 4 

W. Roller 

309 S. Main, Monmouth 61462 

Washington 

Members: 2-Dist. No. 10 

Charles Longwell 

111 S. Washington, Nashville 62263 

Wayne 

Members: 7-Dist. No. 9 

Edward S. Talaga 

101 E. Center St., Fairfield 62837 


Bill R. Fulk 

207 E. Main, DuQuoin 62832 
Joseph Allman 

121 N. Slate St., Monticello 61856 

B. J. Rodriguez 
868 Mortimer, Barry 62312 


C. S. Schlageter 

818 E. Broadway, Sparta 62286 

David R. Benson 

1200 N. East St., Olney 62450 

J. P. Johnston 

1630 5th Ave., Moline 61265 


Clarence J. Oerter 

1915 W. Main, Belleville 62221 


Warren R. Dammers 

P.O. Box 281, Harrisburg 62946 

Robert L. Prentice 
701 N. Walnut, Springfield 62702 


Henry C. Zingher 
West Side Square. Rushville 62681 

Otto G. Kauder 
~P.O. 395, Shelbyville 62565 

Roger Jinkins 

1262 W. Stephenson, Freeport 61032 

Robert M. Wright 
427 1st Nat. Bk. Bldg., Peoria 61602 


William H. Whiting 
Box 410, Anna 62906 

L. W. Tanner 

7 N. Virginia, Danville 61832 
C. L. Johns 

114 W. 5th St., Mt. Carmel 62863 

Glenn W. Chamberlin 
219 E. Euclid, Monmouth 61462 

Jerry L. Beguelin 

Box 197, Irvington 62848 

Arthur Marks 

101 E. Center St., Fairfield 62837 


for October, 197-1 


299 


County 


President 


Secretary 


White 

Members: 8-Dist. No. 9 
Whiteside 

Members: 37-Dist. No. 2 

Will-Grundy 
Members: 195-Dist. No. 11 
Pat Love, Manager 
58 N. Chicago, Rm. 201 
Joliet 60431 

Williamson 

Members: 31-Dist. No. 9 
Winnebago 

Members: 311-Dist. No. 1 
Mrs. Johanna Lund 
Exec. Sec. Adm. 

310 N. Wyman 
Rockford 61101 


William Courtnage 
West Main St., Carmi 62821 

Howard R. Christofersen 
101 E. Miller, Sterling 61081 

Thomas J. Fitzpatrick 
58 N. Chicago, Joliet 60431 


George Murphy 

Marion Mem. Hosp., Marion 62959 

James H. Topp 

310 N. Wyman, Rockford 61101 


Morris McCall 
So. Plum St., Carmi 62821 

James McGee 

1716 Locust, Sterling 61081 

Antanas Razma 
58 N. Chicago, Joliet 60431 


Herbert V. Fine 

110 N. Division, Carterville 62918 
John English 

310 N. Wyman, Rockford 61101 


Woodford 

Members: 8-Dist. No. 2 


Joe C. Phifer 

203 S. Main St., Eureka 61530 


James W. Riley 

109 S. Major St., Eureka 61530 


No Organized County Society 

Johnson 

Marshall 

Putnam 


Joint County Societies 


Cass-Brown 
Coles-Cumberland 
Henry-Stark 
Jefferson -Hamilton 


Jersey-Calhoun 
Morgan-Scott 
Saline-Pope- Hardin 
Will-Grundy 


A major portion of this listing will become obsolete as of January, 1915. An up-to-date listing will be published 
in the delegates handbook section of the March issue of the Illinois Medical Journal. 


Chicago Medical Society 

President: Howard C. Bulkhead 
2650 Ridge, Evanston Hosp., Evanston 60201 
AUX PLAINES BRANCH 
President: Everett E. Nicholas 
1111 Franklin, River Forest 60305 
Secretary: Meredith B. Murray 

414 South Oak Park Ave., Oak Park 60302 
CALUMET BRANCH 
President: James A. K. Lambur 
2055 W. Hopkins Place, Chicago 60620 
Secretary: Bernard P. Flaherty 

3900 W. 95th Street, Evergreen Park 60642 
DOUGLAS PARK BRANCH 
President: Kent F. Borkovec 

175 Northwood Drive, Riverside 60546 
Secretary: Fabian S. Ostrowski 

3601 S. Austin Blvd., Cicero 60650 
ENGLEWOOD BRANCH 
President: Stanley Budrys 
2751 West 51st St., Chicago 60632 
Secretary: 

(To be announced) 

NORTH SUBURBAN BRANCH 
President: Leon L. Am pel 
2701 Oak Street, Northbrook 60062 
Secretary: James E. Vanderbosch 
636 Church St., Evanston 60201 
IRVING PARK SUBURBAN BRANCH 
President: George L. Lagorio 
1625 Forest Drive, Glenview 60025 
Secretary: Arthur Kunis 

668 Diversey, Chicago 60614 
JACKSON PARK BRANCH 
President: Richard Jones 
4820 S. Kenwood, Chicago 60615 
Secretary: Ralph F. Naunton 
950 E. 59th Street, Chicago 60037 
NORTH SIDE BRANCH 


President: Roland R. Cross, Jr. 

724 N. Oak Park Ave., Oak Park 60302 
Secretary: Joseph C. Sherrick 

303 E. Superior St., Chicago 60611 
NORTH SHORE BRANCH 
President: Clarke W. Mangun Jr., 

733 S. Greenwood, Park Ridge 60068 
Secretary: Cyril C. Wiggishoff 
611 Briar Lane, Northfield 60094 
NORTHWEST BRANCH 
President: Jorge Tovar 

3257 N. New England Ave., Chicago 60634 
Secretary: Raymond J. Des Rosiers 
320 Central Avenue, Wilmette 60091 
SOUTH CHICAGO BRANCH 
President: William S. Smith 
1100 East 173rd Place, South Holland 60473 
Secretary: Douglas L. Foster 

7531 S. Stony Island Ave., Chicago 60649 
SOUTH SIDE BRANCH 
President: Kermil Mehlinger 
4901 Drexel Blvd., Chicago 60615 
Secretary: Otto J. Keller 
5825 S. Dorchester Ave., Chicago 60637 
SOUTHERN COOK COUNTY BRANCH 
President: Conrad J. Urban 
2823 W. 173rd Street, Hazelcrest 60429 
Secretary: William J. Marshall 
Athenia Park Medical Bldg. 

2601 Lincoln Highway, Olympia Fields, 60461 
STOCK YARDS BRANCH 
President: Maurice M. Hoeltgen 
4700 W. 95th Street, Oak Lawn 60453 
Secretary: Edwin J. Lukaszewski 
1213 West 51st Street, Chicago 60609 
WEST SIDE BRANCH 
President: Eugene T. Eloban 
6429 West North Ave., Oak Park 60302 
Secretary: Henry Okner 

6435 W. North Avenue, Oak Park 60302 


300 


Illinois Medical Journal 


Wisconsin 



for October, 1974 


301 


TRUSTEE DISTRICT COMMITTEES 


First District 

Joseph L. Bordenave, Geneva, Trustee 
Counties of Boone, Carroll, DeKalb, Jo Daviess, Kane, 
Lake, McHenry, Ogle, Stephenson, Winnebago 


Term 

Ethical Relations Committee Expires 

John H. Steinkamp, Belvidere, Chairman 1975 

Gerald Liesen, St. Charles 1976 

A. M. Rosetti, McHenry 1977 

Paul Burkholder, Rockford 1975 

Peer Review Committe 

Robert Behmer, Rockford 1977 

Charles Picus, Rockford 1975 

Walter J. Reedy, Waukegan 1975 

John E. Madden, Freeport 1976 

Rodney Nelson, Geneva 1975 

Erwin A. Schilling, Rockford 1975 

R. E. Whitsitt, Rockford 1975 


Second District 

Allan L. Goslin, Streator, Trustee 

Counties of Bureau, LaSalle, Lee, Livingston, Marshall, 
Putnam, Whiteside, Woodford 


T ERM 

Ethical Relations Committee Expires 

K. Dexter Nelson, Princeton, Chairman 1977 

William Erkonen, Streator 1975 

Tim Sullivan, Sterling 1976 

Peer Review Committee 

K. M. Nelson, Princeton, Chairman 1975 

M. D. Burnstine, Sterling, Co-Chairman 1976 

James B. Aplington, LaSalle 1976 

LaMonte Ballard, Sterling 1976 

Francis J. Brennan, Utica 1976 

Silvio Davito, Spring Valley 1976 

Bernard J. Doyle, LaSalle 1976 

Donald Edwards, Dixon 1976 

William Ehling, Streator 1977 

Julius Kolis, Dixon 1976 

P. Lymberopoulis, Dixon 1976 

Edward Murphy, Dixon 1977 

Rowland Musick, Mendota 1976 

Theodore Manger, Chatsworth 1975 

Louis Tarsinos, Princeton 1976 

Theodore W. Wagenknecht, Streator 1976 


Third District 

David S. Fox, Olympia Fields, Trustee 
Robert T. Fox, Glenview, Trustee 
Eugene T. Hoban, Oak Park, Trustee 
Joseph Skom, Chicago, Trustee 
William M. Lees, Lincolnwood, Trustee 
George Shropshear, Chicago, Trustee 
Philip G. Thomsen, Dolton, Trustee 
Frederick E. Weiss, Harvey, Trustee 
Warren Young, Crete, Trustee 


Fourth District 

Fred Z. White, Chillicothe, Trustee 

Counties of Fulton, Hancock, Henderson, Henry, Knox, 
McDonough, Mercer, Peoria, Rock Island, Schuyler, 
Stark, Warren 


Term 

Ethical Relations Committee Expires 

Richard Icenogle, Roseville, Chairman 1977 

John Bowman, Abingdon 1976 

George Burke, Rock Island 1975 

Peer Review Committee 

Russell Jensen, Monmouth, Chairman 1976 

William Daugherty, Moline 1975 

Donald Dexter, Macomb 1977 

G. W. Giebelhausen, Peoria 1975 

James C. Parsons, Geneseo 1976 

Clarence Ward, Peoria 1975 


Fifth District 

A. Edward Livingston, Bloomington, Trustee 
Counties of DeWitt, Logan, McLean, Mason, Menard, 
Montgomery, Sangamon, Tazewell 


Term 

Ethical Relations Committee Expires 

William IV. Curtis, Springfield, Chairman 1977 

A. L. Van Ness, Bloomington 1976 

Jack Means, Mason City 1975 

Peer Review Committee 

James Borgerson, Mt. Pulaski, Chairman 1977 

kobert Price, Bioomington, Co-Chairman 1977 

Paul Lafata, Springfield 1977 

George Irwin, Bloomington 1976 

John G. Meyer, Springfield 1975 

Alton J. Morris, Springfield 1976 

Robert B. Perry, Lincoln 1976 

Robert Schaefer, Petersburg 1975 

James Weimer, Pekin 1976 


Sixth District 

Mather Pfeiffenberger, Alton, Trustee 

Counties of Adams, Brown, Calhoun, Cass, Green, Jersey, 
Macoupin, Madison, Morgan, Pike, Scott 


Term 

Ethical Relations Committee Expires 

Newton DuPuy, Quincy 1977 

Bernard Baalman, Hardin 1975 

Edward K. DuVivier, Alton 1977 

Joseph J. Grandone, Gillespie 1977 

Lee Johnson, Staunton 1975 

Peer Review Committee 

Robert R. Hartman, Jacksonville, Chairman 1975 

Meyer Shulman, Pittsfield, Co-Chairman 1977 

E. C. Bone, Jacksonville 1976 

Edward Ragsdale, Alton 1977 

Robert C. Murphy, Quincy 1976 

Frank B. Norbury, Jacksonville 1975 

James Reid, Greenfield 1977 

James W. Sutherland, Quincy 1977 

A. D. Wilson, Carrollton 1975 


302 


Illinois Medical Journal 


Seventh District 

Arthur F. Goodyear, Decatur, Trustee 
Counties of Bond, Christian, Clay, Clinton, Effingham, 
Fayette, Macon, Marion, Moultrie, Piatt, Shelby 


Term 

Ethical Relations Committee Expires 

Carl Sandburg, Decatur, Chairman 1976 

E. H. Rames, Vandalia 1975 


Eighth District 

Eugene P. Johnson, Casey, Trustee 

Counties of Champaign, Clark, Coles, Crawford, Cum- 
berland, Douglas, Edgar, Jasper, Lawrence, Richland, 
Vermillion 


Term 

Ethical Relations Committee Expires 

Mack W. Hollowell, Charleston, Chairman 1977 

James H. Pass, Olney 1975 

Alan M. Taylor, Danville 1976 

Peer Review Committee 

E. T. Baumgart, Danville, Chairman 1977 

James W. Landis, Olney, Co-Chairman 1977 

E. A. Kendall, Mattoon 1976 

George T. Mitchell, Marshall 1975 

Gordon Sprague, Paris 1976 


Peer Review' Committee 

Stanley Moore, Vandalia, Chairman 1976 

M. K. Kaufman, Greenville 1977 

H. Gale Zacheis, Decatur 1977 

Walter P. Plassman, Centralia 1976 

William Sargeant, Effingham 1976 


Ninth District 

Warren D. Tuttle, Harrisburg, Trustee 
Counties of Edwards, Franklin, Gallatin, Hamilton, Har- 
din, Jefferson, Johnson, Massac, Pope, Saline, Wabash, 
Wayne, White, Williamson 


Term 

Ethical Relations Committee Expires 

Andrew Krajec, West Salem, Chairman 1976 

Antonio Boba, Mt. Vernon 1977 

Elliott Partridge, Eldorado 1977 


Peer Review Committee 

C. J. Jannings, HI, Fairfield. Chairman 1976 

Philip Boren, Carmi 1977 

James Durham, Benton 1975 

Herbert Fine, Carterville 1975 

Ernest Lowenstein, Mt. Carmel 1976 

Charles K. Wells, Mt. Vernon 1975 


Tenth District 

Herbert Dexheimer, Belleville, Trustee 

Counties of Alexander, Jackson, Monroe, Perry, Pulaski, 


Randolph, St. Clair, Union, Washington 

Term 

Ethical Relations Committee Expires 

A. L. Robinson, Mounds, Chairman 1976 

Wiiliam Borgsmiller, Murphysboro 1975 

Peter Soto, Belleville 1977 

Peer Review Committee 

Joseph A. Petrazio, Murphysboro, Chairman 1976 


Eleventh District 

Ross N. Hutchison, Gibson City, Trustee 
Counties of DuPage, Ford, Grundy, Iroquois, Kankakee, 
Kendall, Will 


Term 

Ethical Relations Committee Expires 

James Ryan, Kankakee, Chairman 1975 

John Bowden, Joliet 1976 

Lawrence D. Lee, Manhattan 1976 


Peer Review Committee 

1975 

1975 

1976 

1975 

1976 

1977 
1977 


Charles Baldree, Belleville 1976 

Eli Borken, Carbondale 1976 

R. W. Jost, Waterloo 1975 

B. Kinsman, DuQuoin 1976 

Robert Rader, Anna 1977 

R. E. Schettler, Red Bud 1977 

William H. Walton, Belleville 1975 

Charles L. Yarbrough, Cairo 1976 


James Campbell, Wheaton, Chairman 

James E. Dailey, Watseka 

James Lambert, Joliet 

Guy Pandola, Joliet 

William C. Perkins, West Chicago 

A. G. Parkhurst, Kankakee 

W. H. Brill, Oswego 


for October, 197-t 


303 



HOUSE OF 
DELEGATES 




Councils of the Illinois State Medical Society 

Councils of the Illinois State Medical Society are appointed by the Chairman of the Board of Trustees subject to 
approval of the Board of Trustees. The councils are composed of such members as are necessary to accomplish the 
purposes of the council. Some committees are composed of members of the Board of Trustees and are designated 
Board Committees. Some free standing committees may report directly to the board and may not be assigned to a coun- 
cil. Task Forces are established to address a particular problem or concern which crosses areas of responsibility of 
the several councils. The task forces report directly to the board, as do representatives to various other agencies. The 
President, President-Elect, Speaker of the House, and Chairman of the Board are, by virtue of their office, ex-officio 
members of all groups. 

COUNCIL ON AFFILIATE SOCIETIES 


Samuel Cloninger, Chairman 
III. Radiological Society 
64 Old Orchard, Skokie 60076 
Robert Bettasso 

III. Chap., Amer. Coll, of Surgeons 
1703 Polaris Circle, Ottawa 61350 
Lawrence Breslow 

111. Chap., Amer. Academy of Pediatrics 
1500 Shermer Rd., Northbrook 60062 
Edward Brunner 

111. Soc. of Anesthesiologists 
303 E. Chicago Ave., Chicago 6061 1 
Wm. B. Buckingham 
III. Soc. of Internal Medicine 
30 North Michigan. Chicago 60602 
James Burden 

Chicago Urological Society 
720 N. Michigan, Chicago 60611 
Jan Fawcett 
III. Psychiatric Society 
1720 West Polk St., Chicago 60612 
Norman M. Frank 

111. Chap., Amer. Academy of Family Phy. 

421 Park Ave., Clarendon Hills 60514 
Jack Gibbs 

111. Surgical Society 
175 Main St., Canton 61520 
David Heiberg 

III. Assoc, of Ophthalmology 
1702 Washington St., Waukegan 60085 
W. R. Malony 

III. Ob-Gyn. Society 

Carbondale Clinic, Box 2347, Carbondale 62901 


Robert C. Muehrcke 
111. Chap., Amer. College of Phy. 

518 N. Austin Blvd., Oak Park 60302 
Simon Ramah 

111. Society of Pathology 

St. Bernards Hosp., 6337 S. Harvard, Chicago 60621 
Bill B. Smiley 

III. Chap., Amer. Coll, of Enter. Rnt. Phy. 

2155 Hoyt Court, Decatur 62526 
E. B. Sylvester 

111. Section. Amer. Coll, of Ob-Gyn. 

57 N. Ottawa, Joliet 60431 

Alternates 

Donald H. Hanscom 

111. Soc. of Internal Medicine 
40 So. Clay St., Hinsdale 60521 
Robert M. Kark 

III. Chap., Anter. Coll, of Phy. 

1753 W. Congress, Chicago 60612 
Albert L. Pisan i 

111. Chap., Amer. Academy of Pediatrics 
40 So. Clay St., Hinsdale 60521 

Responsibilities and Purposes: 

To improve communication and provide liaison with 
the specialty societies; provide specialty consultation to 
other ISMS councils and committees; and to serve as a 
resource unit to ISMS on advances in the medical special- 
ties. 

Staff; James Kopriva 


COUNCIL ON ECONOMICS AND PEER REVIEW 


Robert J. Becker, Chairman 
229 N. Hammes, Joliet 60435 
Theodore Donosky 
800 S. Main, Benton 62812 
Earl E. Fredrick Jr. 

10830 Halsted, Chicago 60628 
Homer Goldstein 

Box 144, Libertyville 60048 
A. Beaumont Johnson 
860 Summit, Elgin 60120 
Michael Murray 

1200 N. East, Olney 62450 
Luke R. Pascale 

18668 Dixie Highway, Homewood 60430 
Maynard I. Shapiro 
7531 Stony Island Ave., Chicago 60649 
Joseph Silverstein 

1616 Sheridan Rd., Wilmette 60091 


Cyril C. Wiggishoff 
25 E. Washington St., Chicago 60602 
Ben Williams 

1400 W. Park Ave., Urbana 61801 
Consultants; 

David S. Fox 

20829 Greenwood Center Ct., Olympia Field 60461 
Warren W. Young 

3450 Haweswood Dr., Crete 60417 
Eugene P. Johnson 

P.O. Box 68, Casey 62420 
Physician-in -Training: 

Ronald T. Staubly 
419 N. 7th, Springfield 62701 
Student Representative: 

Wayne Domin 

829 Simpson St., Evanston 60201 
Staff: Joseph J. Lotharios 


for October, 1974 


305 


Committees: 

Peer Review Appeals 
Relative Value Study 

Responsibilities and Purposes: 

The Council on Economics & Peer Review shall con- 
cern itself with: 1) relations with the health insurance 


industry and prepayment plans; 2) fees and fee adjudica- 
tion as promulgated by the ISMS; 3) health care cost 
and utilization; 4) new modes of health care delivery 
(HMOs, prepaid programs) ; 5) health care planning pro- 
grams (CHP, IRMP, etc.), 6) serving as the appellate 
body for peer review in the state. 


Council Members: 

Earl E. Fredrick, Jr., Chairman 
Theodore Donosky 
A. Beaumont Johnson 
Michael Murray 
Staff: Josph J. Lotharius 


PEER REVIEW APPEALS COMMITTEE 

Responsibilities and Purposes: 

The Peer Review Appeals Committee serves as the 
appellate body for peer review in the state. It considers 
cases being appealed from local or district Peer Review 
committees involving quality and quantity of medical care. 
The committee also serves as liaison to local peer review 
committees and offers its assistance whenever requested. 


RELATIVE VALUE 

Council Member: 

Ben Williams, Chairman 
Non-Council Members: 

Joseph L. D'Silva 

513 Kin Court, Wilmette 60091 
John L. Eaton 

2855-1 8th St., C, Moline 61265 
Clifton L. Reeder 

734 N. Merrill Ave., Park Ridge 60068 


STUDY COMMITTEE 

Consultant: 

Jacob E. Reisch 

1129 S. 2nd St., Springfield 62704 
Staff: Joseph J. Lotharius 

Responsibilities and Purposes: 

The Committee’s purpose is a positive effort to develop 
an Illinois relative value study. 


COUNCIL ON EDUCATION AND MANPOWER 


Morgan M. Meyer, Chairman 
815 S. Main, Lombard 60148 
Allison L. Burdick, Jr., Vice Chairman 
(Adv. to Physicians-in-Training) 

Carl R. Barthelemy 

175 S. Main, Canton 61520 
J. Ernest Breed 

(Liaison to Illinois Council on CME ) 

55 E. Washington St., Chicago 60602 
George O. Dohrmann 

3000 W. Logan Blvd., Chicago 60647 
N. Kenneth Furlong 

221 N.E. Glen Oak Ave., Peoria 61603 
Larry C. Gunn 
40 So. Clay, Hinsdale 60521 
Lawrence L. Hirsch 
836 Wellington. Chicago 60657 
Forrest H. Riordan, M.D. 

5670 E. State, Rockford 61108 
Gonzalo Ruiz 

1937 N. Cleveland, Chicago 60614 
Joseph R. Shackelford 
562 Shaw, Paris 61944 
Consultants: 

Robert T. Fox 

2136 Robin Crest Lane, Glenview 60025 
Allan L. Goslin 

712 N. Bloomington, Streator 61364 
William M. Lees 

6518 N. Nokomis Ave., Lincolnwood 60646 
Fred Z. White 

723 N. Second St„ Chillicothe 61523 
Interns and Residents: 

Michael J. Hughey 
711 Laurel Ave., Wilmette 60091 


Student Representatives: 

Alan Roman 

2121 Collete Lane, Flossmoor 60422 
William Yasnoff 

710 N. Lake Shore Dr., Chicago 60611 

Representatives of Medical Schools: 

Chicago Medical School 
James Shaffer 

2020 Ogden Ave., Chicago 60612 
University of Chicago— Pritzker School of Medicine 
Clifford W. Gurney 

950 E. 59th St., Chicago 60637 
University of Illinois College of Medicine 
Robert L. Evans 

1601 Parkview, Rockford 61101 
Loyola Unix’ersity Stritch School of Medicine 
William B. Rich 
2160 S. 1st, Maywood 60153 
Northwestern Medical School 
Jacob Suker 

303 E. Chicago Ave., Chicago 60611 
Rush Medical School 
John Graettinger 

Rush Presbyterian-St. Lukes Medical Center 
Chicago 60612 

Southern Illinois University Medical School 
Dax Taylor 

715 E. Carpenter, Springfield 62702 
Siaff: Philip Thomsen II 

Responsibilities and Purposes: 

The Council on Education and Manpower shall study 
and evaluate all phases of medical education, including 
the development of programs by and for ISMS, and re- 


306 


Illinois Medical Journal! 


view programs for paramedical personnel. It shall carry 
to the deans of medical schools recommendations from 
the viewpoint of the practicing physician. It shall evalu- 
ate available postgraduate programs, advise the Illinois 
Dept, of R&E, and review hospital oriented education 
programs. Liaison shall be maintained with the advisory 
committee to students and physicians-in-training and with 
loan programs for medical students. Actiivties regarding 
physician distribution and retention shall also be within 

COMMITTEE ON 

Council Members: 

N. Kenneth Furlong, Chairman 
George O. Dohrmann 
Non-Council Members: 

John H. Huss 

315 Schiller St., Elmhurst 60126 
L. P. Johnson 

1601 Parkview, Rockford 61101 
Howard L. Lange 
211 So. 3rd St., Belleville 62221 

LIAISON COMMITTEE TO 

Council Member: 

Morgan M. Meyer 

Governmental Affairs Council Representative: 

George T. Wilkins 

3165 Myrtle Ave., Granite City 62040 


the scope of the Council, as well as medical licensure as it 
relates to education. 

Committees : 

Accreditation 

Liaison to Council of Deans 
Manpower 

Advisory Committee to Medical Students 
Advisory Committee to Physicians-in-Training 

ACCREDITATION 

Rex O. McMorris 

619 N.E. Glen Oak, Peoria 61603 
Staff: Philip G. Thomsen II 

Responsibilities and Purposes: 

To review survey reports of institutions which have 
applied for accredited status and grant accreditation to 
promote Continuing Medical Education activities; to pro- 
vide liaison with the Illinois Council on Continuing Medi- 
cal Educaton. 

THE COUNCIL OF DEANS 

Illinois Council on Continuing Medical Education 
Representative: 

Dean R. Bordeaux 

2421 W. Rohmann Ave., Peoria 61604 
Staff: Philip G. Thomsen II 


MANPOWER SUBCOMMITTEE 


Council Members: 

Lawrence L. Hirsch 
Gonzalo Ruiz 
Non-Council Members: 

William R. Durham 

203 North Vine St., Harrisburg 62946 
Charles M. Maples 
408 South Cross, Robinson 62454 


Consultants: 

Eugene Johnson 

Casey Medical Center 
P.O. Box 68, Casey 62420 
Frederick E. Weiss 

15643 Lincoln Ave., Harvey 60426 
Fred Z. White 

723 N. Second St., Chillicothe 61523 
Staff: Philip G. Thomsen II 


ADVISORY COMMITTEE TO MEDICAL STUDENTS 


Carl Barthelemy, Chairman 
175 S. Main St., Canton 61520 
Larry Herron 

542 Main St., Bridgeport 62417 
Richard J. Jones 
4920 S. Kenwood, Chicago 60615 
Paul S. Reeder 

1950 N. Water St., Decatur 62526 
Forrest Riordan 

6670 E. State St., Rockford 61108 
Glen Tomlinson 

4 Lincoln Professional Park, Lincoln 62656 
Theodore R. Van Dellen 
435 N. Michigan Ave., Chicago 60611 
Student Representatives: 

J. Bob Achebe (Rush) 

4930 S. Woodlawn, Chicago 60615 


Margaret Donovan ( Loyola ) 

1815 S. Wolf Rd., Hinsdale 60162 
Lawrence Kanter (U. Chicago) 

4800 S. Lake Park, Chicago 60615 
David Rollins (MECO) 

408 N. Taylor St., Apt. 3A, Oak Park 60302 
Alan Roman (Chicago Medical) 

2121 Colette Lane, Flossmoor 60422 
Gary Stabler (Chicago Osteopathic) 

327 S. Wisconsin St., Apt. 2B, Oark Park 30302 
Jeff Waitzman ( Illinois ) 

1431 W. Farwell, Chicago 60626 
William Yasnoff (Northwestern) 

710 N. Lake Shore Dr., Chicago 60611 

Staff: Perry Smithers 


ADVISORY COMMITTEE TO PHYSICIANS-IN-TRAINING 


Allison Burdick, Jr. Chairman 
1637 N. Mobile, Chicago 60639 

James R. Buechler 

410 N. Second St., Marshall 62441 

Larry C. Gunn 

40 S. Clay St., Hinsdale 60521 


Vernon L. Zech 

St. Therese Hospital, Waukegan 60685 
Physicians-in-Training: 

Edith Hartman 

1601 W. Taylor St., Chicago 60612 
Michael Hughey 

711 Laurel Ave., Wilmette 60091 


for October, 1974 


307 


James J. McCoy 

643 N. Harvey, Oak Park 60302 

Marc Rose 

7401 N. Kostner, Skokie 60076 

Ronald T. Staubly 

320 N. 9th St., Springfield 62702 


Barry Storter 

886 Cambridge, Buffalo Grove 60090 
Paul M. Stromborg 

1741 N. Neva, Chicago 60635 
Kong-Meng Tan 
521 W. Briar, Chicago 60657 
Staff: Perry Smithers 


COUNCIL ON ENVIRONMENTAL AND COMMUNITY HEALTH 


Julius M. Kowalski, Chairman 

(Liaison with Environmental Groups) 

436 Park Avenue E., Princeton 61356 
James P. Campbell 

322 N. Blanchard, Wheaton 60187 
William W. Curtis 

100 W. Miller, Springfield 62702 
Thomas Davison 

(Liaison with Industrial Medicine) 

17 N. Clinton St., Chicago 60606 
John S. Hipskind 

301 W. Lincoln, Belleville 62221 
Eduard Jung 

17030 So. Wausau Ave., South Holland 60473 
Daniel J. Pachman 

(Liaison with Pediatric Coordinating Council) 
1212 N. Lake Shore Drive, Chicago 60610 
Stephen E. Reid 

2500 Ridge Ave., Evanston 60201 
Richard C. Treanor 

1430 N. State Rd., Arlington Heights 60004 
William H. Weiss 

(Liaison with EENT ir Otolaryngology Soc.) 
118 W. Laurel, Springfield 62704 
Consultants: 

Byron Francis 

State of Illinois, Dept, of Public Health 
535 W. Jefferson St., Springfield 62761 
Robert R. Hartman 

1515A W. Walnut, Jacksonville 62650 
Edward A. Piszczek 
6410 N. Leona, Chicago 60646 
Warren W. Young 

11541 S. Champlain Ave., Chicago 60628 
Interns and Resident: 

Barry M. Storter 

886 Cambridge Dr., Buffalo Grove 60090 


Student Representative: 

Linda Lee Hughey 
711 Laurel Ave., Wilmette 60091 

Auxiliary: 

Mrs. Edward Szewczyk (Betty) 

17 Oak Knoll, Belleville 62223 

Staff: Philip G. Thomsen II 

Responsibilities and Purposes: 

The Council on Environmental & Community Health 
shall cooperate with the Illinois Department of Public 
Health in specific areas. Its responsibilities shall include 
the maintenance, protection and improvement of the 
health of the people of Illinois through organized com- 
munity efforts. 

It shall serve as a source of information on chronic 
illness and communicable diseases and cooperate with in- 
stitutions and voluntary health agencies in disseminating 
such information. 

It is responsible for medicine’s interest in the rela- 
tionship of man to his surroundings, particularly air, 
water and soil pollution; health problems related to 
population growth, urbanization and technological de- 
velopment bearing on the ecology of man. 

The council also shall be concerned with diseases and 
problems associated with occupational and industrial 
health, cooperate with the Council on Occupational 
Health of AMA, Industrial Medical Association and simi- 
lar state agencies and to recommend to the State of Illi- 
nois Workman’s Compensation Board medical procedures 
designed to assist the board in the evaluation of claims. 

Committees : 

Ear, Nose and Throat Health 
Maternal Welfare 
Sports Medicine 


COMMITTEE ON EAR, I 

Council Member: 

William H. Weiss, Chairman 
Non-Council Members: 

Andreas G. Kodros 
4640 N. Marine Drive, Chicago 60640 
R. Marcus 

64 Old Orchard— Suite 229, Skokie 60076 
Ralph F. Naunton 

950 E. 59th St., Box 412, Chicago 60637 
Guy O. Pfeiffer 

Link Clinic, 213 S. 17th St.. Mattoon 61938 

COMMITTEE ON 

William W. Curtis, Chairman 
Districts Members and Alternates 
(alternates in italics) 

1 . William J. Weigel 
57 E. Downer PL, Aurora 60506 


E AND THROAT HEALTH 

Staff: Philip G. Thomsen II 

Responsibilities and Purposes: 

The function of the Ear, Nose and Throat Health Com- 
mittee is to concern itself with state legislation regarding 
Laryngological and Otological matters, to secure and dis- 
seminate information and make recommendations regard- 
ing specific legislative proposals. The Ear, Nose and 
Throat Health Committee shall also work in connection 
with the Chicago Laryngological and Otological Society. 

MATERNAL WELFARE 

Gerald F. Staub 

119 W. Union, Rockton 61072 
2. William J. Farley 

710 Peoria St., Peru 61354 


308 


Illinois Medical Journal 


Donald M. Gallagher 

Marshall-Putnam Clinic S.C. 

Granville 61326 

3. Melvin Goodman 

13826 Lincoln Ave., Dolton 60419 
Charles F. Kramer 

12647 S. Justin St., Calumet Park 60643 

4. V. B. Adams 

301 E. Jefferson, Macomb 61455 
Ralph Gibson 

416 St. Marks Ct., Peoria 61603 

5. William W. Curtis 

100 W. Miller, Springfield 62702 
Robert Maletich 

1025 S. 7th St., Springfield 62703 

6. Richard D. Yoder 

601 E. 3rd St., Alton 62002 
Donald E. Hardback 
2856 Beltline, Alton 62002 

7. Paul A. Raber 

149 W. King St., Decatur 62521 
Hubert Magi 1 1 

1170 E. Riverside, Decatur 62521 

8. John C. Mason, Jr. 

715 N. Logan, Danville 61832 

AD-HOC COMMITTEE 

Council Member: 

Stephen E. Reid, Chairman 
Non-Council Members: 

Bernad R. Cahill 
416 St. Mark Ct., Peoria 61614 
Eugene F. Diamond 

11055 S. St. Louis Ave., Chicago 60655 
Robert C. Kirkwood 

Kensler Bldg., Lawrenceville 62439 
Donald Ross 

401 E. Springfield, Champaign 61820 
Howard }. Sweeny 
2500 Ridge Ave., Evanston 60201 


J. Roger Powell 

Carle Clinic Association 
602 W. University Ave., Urbana 61801 

9. William B. Skaggs 
Doctor’s Clinic 

203 N. Vine, Harrisburg 62946 
Donald R. Risely 

319 Market St., Mt. Carmel 62863 

10. Arthur A. Smith 
306 E. Eighth St., O’Fallon 62269 

William J. Malony 
Carbondale Clinic 
P.O. Box 2347, Carbondale 62901 

11. John J. McLaughlin 
2100 Glenwood Ave., Joliet 60435 

Charles P. Westfall 

172 Schiller, Elmhurst 60126 
Consultants: 

John Louis 

10721 S. Hoyne, Chicago 60643 
Willard C. Scrivner 

Suite #2, 6600 W. Main St., Belleville 62223 
Augusta Webster 

707 N. Fairbanks C.t., Chicago 6061 1 
Robert R. Hartman 

1515A Walnut St., Jacksonville 62650 
Staff: Philip G. Thomsen II 

ON SPORTS MEDICINE 

Consultant: 

J. M. Ingalls 

502 Shaw, Paris 61944 
Staff: Philip G. Thomsen II 

Responsibilities and Purposes: 

The Committee’s purpose is to promote safe, healthful 
athletic activities for all Illinois children. The Committee 
will encourage conferences and other programs to educate 
trainers and coaches on the proper handling of injuries 
and the physical and psychological problems of athletic 
participation by children. It will cooperate with programs 
which encourage high school students to consider training 
as a career. 


GOVERNMENTAL 

George T. Wilkins, Chairman 

3165 Myrtle Avenue, Granite City, 62040 
James Laidlaw, Vice-Chairman 

Christie Clinic, 104 W. Clark, Champaign 61820 
Finley W. Brown, Jr. 

1445 N. State Parkway, Chicago 60610 
George H. Burke 

Rock Island Franciscan Hospital, 2701 - 1 7 th. 

Rock Island 61201 
David J. Clark 

1780 W. Galena, Aurora 60506 
Alfred J. Faber 

2110 Swainwood Drive, Glenview 60025 
Edward G. Ference 
932 S. Second, Springfield 62704 
Frank J. Jirka, Jr. 

1507 Keystone, River Forest 60305 
Warren W. Kreft 
940 Lee Street, Des Plaines 60016 
John W. Ovitz 

204 W. Elm Street, Sycamore, 60178 
Elliott Partridge 

1201 Pine Street, Eldorado 62930 
Robert Pierce 

1415 E. State Street, Rockford 61108 


AFFAIRS COUNCIL 

Consultants: 

Robert Fox 

2136 Robin Crest, Glenview 60025 
J. M. Ingalls 
502 Shaw, Paris 61944 
Eugene Johnson 

P.O. Box 68, C.asey 62420 
William M. Lees 
6518 N. Nokomis, Lincoln 60646 
Willard C. Scrivner 

Suite 2, 6600 W. Main, Belleville 62223 
Mrs. Pam Taylor 

1607 N. Vermilion, Danville 61832 
Philip G. Thomsen 

13826 Lincoln Avenue, Dolton 60419 

Student Representative: 

John Hall 

12 Harrison Street, Oak Park 

Auxiliary Representative: 

Mrs. Alton (Sharon) Morris 
1616 Leland, Springfield 
Staff: Don Udstuen 

Responsibilities and Purposes: 

1. Keep the Society and its members aware of all state 
and federal legislation and laws affecting the health of 


for October, 1974 


309 


Committees: 


citizens o£ Illinois and the practice of medicine in Illinois. 

2. Promulgate legislation to improve the health care of 
citizens of Illinois and the practice of medicine in Illinois. 

3. Co-operate with the AMA in similar programs. 

4. Develop programs to educate the public and the 
Illinois State Medical Society membership in the privi- 
leges and responsibilities of citizenship. 


Eye Health 
Forensic Medicine 
Legal Definition of Death 
National Legislation Committee 
Public Affairs 


EYE HEALTH COMMITTEE 


Council Member: 

Warren W. Kreft, Chairman 
Non-Council Members: 

Frederick Crowley 

117 Bellemount Road, Bloomington 61701 
Maurice M. Hoeltgen 

1836 West 87th St., Chicago 60620 
Paul Hauser 

2500 Ridge Ave., Evanston 60201 


Edward Kwedar 
615 S. 7th, Springfield 62703 
Samuel Schall 

30 N. Michigan, Chicago 60602 
Frank Snell 

334 West Main, Decatur 62522 
Robert W. Webb 

213 South Charles, Edwardsville 62025 
Staff: Don Udstuen 


AD HOC COMMITTEE ON FORENSIC MEDICINE 


Grant C. Johnson 

Memorial Hospital, First and Miller Street, 
Springfield 62705 
Thomas P. DeGraffenried 

1208 Stinnymeade, DeKalk 60115 
Victor Levine 

Apt. 801, 1700 E. 56th Street, Chicago 60637 
Donal D. O’Sullivan 

Augustana Hospital. 411 W. Dickens, Chicago 60614 


James H. Ryan 
401 N. Wall, Kankakee 60901 
Karl Sohlberg 

Methodist Hospital, Peoria 61605 
Robert Stein 

2926 Arlington Avenue, Highland Park 60035 
Robert Wissler 

950 E. 59th Street, Chicago 60637 
Staff: Don Udstuen 


COMMITTEE ON 

Jacob E. Rcisch, Chairman 

1129 S. 2nd St., Springfield 62704 
Thomas Baffes 

Dept, of Surgery, Mt. Sinai Hospital 
2755 VV. 15th St., Chicago 60608 
Benjamin Boshes 


LEGAL DEFINITION OF DEATH 

303 E. Chicago, Chicago 60611 
William Dye 

3200 Highland, Downers Grove 60515 
Fred Merkel 

151 Sheridan Road, Kenilworth 60643 
Staff: Don Udstuen 


NATIONAL LEGISLATION COMMITTEE 


Council Members: 

George T. Wilkins, Chairman 
Alfred J. Faber 
Frank J. Jirka, Jr. 

James Laidlaw 
Elliott Partridge 
Consultants: 

Joseph L. Bordenave 

1665 South Street, Geneva 60134 
Fredric D. Lake 

1041 Michigan Avenue, Evanston 60202 
William M. Lees 

6518 N. Nokomis, Lincolnwood 60646 


P. John Seward 

1601 Parkview, Rockford 61107 
Staff: Don Udstuen 

Responsibilities and Purposes: 

The National Legislation Committee was formed in 1974 
at the request of the Board of Trustees. Its purpose is to 
study national legislative proposals which have impact on 
the health care delivery system in Illinois and to promul- 
gate proposals designed to improve the quality of health 
care and the practice of medicine in Illinois. The Com- 
mittee will also serve as a source of information to ISMS 
members on the status of such proposals. 


PUBLIC AFFAIRS COMMITTEE 


Council Members: 

Elliott Partridge, Chairman 
Robert Pierce, Vice Chairman 
Finley W. Brown, Jr. 

James Laidlaw 
John W. Ovitz 
George T. Wilkins 
Non Council Members: 

Theodore F. Bartlett 

7447 Pottawatomi Drive, Palos Heights 60463 
Louis Dondanville 

501— 15th Street, Moline 61265 


Joseph Flinkamp 

1775 Glenview Road, Glenview 
Earl V. Klaren 

158 E. Cook Street, Libertyville 60048 
Frank J. Kresca 

208 W. Green Street, Champaign 61820 
Paul Mahon 

326 N. 7th, Springfield 62701 
Thomas P. Meirink 

8601 W. Main, Belleville 62223 
George T. Mitchell 

Cork Medical Center, 410 N. 2nd, Marshall 62441 


310 


Illinois Medical Journal 


Tassos Nassos 

3929 N. Central, Chicago 60634 
Donal 1). O’Sullivan 

Augustana Hospital. 411 W. Dickens, Chicago 60614 
Albert W. Ray, Jr. 

301 N. Reed Street, Joliet 60435 
David Rendleman 
Box 2347, Carbondale 62901 
James H. Ryan 

401 N. Wall, Kankakee 60901 


A. E. Steer 

701 N. Walnut, Bldg. A, Springfield 62707 
Lorin D. Whittaker 

840 Jefferson Building, Peoria 61602 

Auxiliary Representative 
Mrs. Stanley (Barbara) Burris 

1630 Wiggins Ave., Springfield 62704 

Staff: Bob Kjellander 


Leonard Klalta, Chairman 
57 W. Jefferson, Joliet 60431 
James Habegger, Vice Chairman 
(Laboratory Services) 

32 S. Lincoln, Geneva 60134 
Herman Wing (IMT) 

836 W. Wellington, Chicago 60645 
Donal D. O’Sullivan 
(Interprofessional Code) 

411 W. Dickens, Chicago 60614 
William Schwingel 
(Arbitration) 

1240 N. Highland Ave., Aurora 60506 
Marshal Segal 

650 Wrightwood. Chicago 60614 
Eli Tobias 

1330 Braeburn Rd., Flossmoor 60422 
Constantine Veremakis 

409 E. Park Dr., Belleville 62223 
Eugene Vickery 

202 S. Schuyler, Lena 61048 
Arnold Wagner 
2500 Ridge, Evanston 60201 
Consultants: 

Jacob E. Reisch 

1129 S. Second St., Springfield 62704 
Allan Goslin 

712 N. Bloomington, Streator 61634 
Herbert Dexheimer 

301 S. Illinois, Belleville 62223 
James Fletcher, Esq. 
c/o Burditt and Calkins, 


MEDICAL LEGAL COUNCIL 

135 S. LaSalle St., Chicago 60603 
Student Representative: 

David Hopp 

5715 S. Drexel, Chicago 60637 
Physician -in-Training Representative: 

Marc Rose 

7401 N. Kostner, Skokie 60076 
Staff: Richard A. Ott 

Responsibilities and Purposes: 

The Medical Legal Council shall cooperate with all 
organizations interested in medico-legal problems in order 
to educate members of the profession in medico-legal 
affairs. 

This council shall maintain liaison with the Illinois 
Bar Association and cooperate with the judiciary in both 
federal and state courts within the state of Illinois. It 
shall, when requested by the court, activate the Impartial 
Medical Testimony panel. The stated objective of the 
panel is to provide consultations, judgment and opinions 
in situations in which there is unusual controversy or wide 
divergence of medical opinion. 

The council shall effect methods of elevating and main- 
taining the standards of medical laboratories in Illinois 
and encourage the use of medical diagnostic laboratories 
supervised by duly qualified physicians. In addition, the 
council shall be concerned with standards of practice and 
quackery. 

Committees : 

Arbitration 

Impartial Medical Testimony 

Laboratory Services 


COMMITTEE 

Council Member: 

William Schwingel, Chairman 
Non-Council Members: 

Clinton Compere 

233 E. Erie, Chicago 6061 1 
David T. Petty 

316 N. Michigan, Chicago 60601 

COMMITTEE ON 

Council Member: 

James Habegger, Chairman 
Non-Council Members: 

Coye Mason 

4720 W. Montrose, Chicago 
Richard Novak 

1601 Parkview, Rockford 
Bernard Stodsky 
4824 N. Karlov, Chicago 
Earl Suckow 

617 Glendale, Mt. Prospect 60056 
Victor Aydt 

Paris Community Hospital, Paris 61944 


ON ARBITRATION 

Vincent Sarley 

682 Pine. Deerfield 60015 
Staff: Richard A. Ott 

Responsibilities and Purposes: 

The committee shall review alternatives available to the 
medical profession in amelioration of professional liability 
litigation: to this end it is engaged in establishing pilot 
projects for screening panels, arbitration or other activities. 

LABORATORY SERVICES 

Joseph O. Dean, Jr. 

Proctor Hospital, Peoria 61604 
Siaff: Richard A. Ott 

Responsibilities and Purposes: 

The committee shall effect methods of elevating and 
maintaining the standards of medical laboratories in 
Illinois, encourage the use of medical diagnostic labora- 
tories supervised by duly qualified physicians and encour- 
age each county and district to establish evaluation com- 
mittees. It will cooperate with various state agencies in 
promoting a safe, adequate blood supply for the state. 


for October, 1974 


311 


COUNCIL ON MENTAL HEALTH AND ADDICTION 


S. Dale Loomis, Chairman 
923 W. Wellington, Chicago 
J. Richard Gallagher 

1330 N. Lake, Aurora 60506 
Ronald Shlensky 

251 E. Chicago, Suite 930, Chicago 60611 
Howard D. Kurland 
636 Church St., Evanston 60201 
Donovan Wright 

135 S. Kenilworth. Elmhurst 60126 
W. David Steed 

(Alcoholism and Drug Dependence) 

1011 Lake St., Suite 423-4, Oak Tark 60301 
Thomas W. Stach 

620 Oakbrook Prof. Bldg., Oak Brook 60521 
Albert W. Ray, Jr. 

(Drug Misuse Education) 

301 N. Reed, Joliet 60435 
Warren R. Dammers 

203 N. Vine St., Harrisburg 62946 
Robert Nunn 
(IPS Liaison ) 

180 N. Michigan Ave., Chicago 60601 
Consultants: 

Joseph Skom 

707 N. Fairbanks C,t., Chicago 
LeRoy Levitt, Director 

Illinois Dept, of Mental Health 
160 N. I.aSalle St., Chicago 60601 

COMMITTEE ON ALCOHOLISM 

Council Members: 

W. David Steed, Chairman 
Albert Ray, Jr. 

(Education Programs) 

Non-Council Members: 

Charles Anderson 

120 N. Oak, Hinsdale 60521 
Kermit Mehlinger 
4901 Drexel Blvd., Chicago 60615 
George Silvest 

Lowell Park Rcl., Dixon 61021 
James West 

2800 W. 95th St., Evergreen Pk. 60642 
George Stanton 

55 It. Washington Blvd., Chicago 60602 

Consultants: 

Edward Senay, IDAP 

1440 S. Indiana, 3rd floor, Chicago 60605 


Student Representative: 

Connie Wehling 
2234 N. Seminary, Chicago 

Physician -in -Training Representative: 

Edith Hartman 

1601 W. Taylor, Chicago 

Auxiliary Member: 

Mrs. H. Frank Holman 
302 Paddock Rd„ Belleville 62223 

Siaff: Richard A. Ott 

Committees : 

Alcoholism and Drug Dependence 

Responsibilities and Purposes: 

This council shall serve as a source of information 
on mental health matters for ISMS, evaluate informa- 
tion and make recommendations to the Board of Trustees 
on positions ISMS should take on issues in this area, 
and cooperate with institutions, voluntary health agencies, 
state agencies and professional associations in disseminat- 
ing information on mental health, alcoholism and drug 
abuse. 

The council shall be on the alert for misleading or 
fallacious programs and information and recommend 
appropriate action. It shall also be concerned with review- 
ing legislation related to the field of mental health, 
alcoholism, drug abuse, and hazardous substances. 

AND DRUG DEPENDENCE 

Joseph Skom 

707 N. Fairbanks C'.t., Chicago 60611 
Staff: Richard A. Ott 

Responsibilities and Purposes: 

The Committee shall work closely with public and 
private agencies on projects aimed at eliminating the mis- 
use of alcohol and drugs. The committee's functions will 
include: (1) study, research and dissemination of educa- 
tional information on drugs anil alcohol to members of 
the medical profession: (2) cooperate in the dissemination 
of information on the causes, prevention, diagnosis and 
treatment of alcoholism and drug dependence to the 
medical profession and to the public; (3) recommend 
acceptable measures for control of distribution and dis- 
posal of drugs and hazardous substances, exclusive of 
radiation products, and (4) to cooperate with official and 
non-official agencies in all matters pertaining to this 
subject. 


COUNCIL ON PUBLIC RELATIONS AND MEMBERSHIP SERVICES 


Paul J. Biedenharn, Chairman 
Medical Arts Building, New Baden 62265 
Man Taylor, Vice-Chairman 
1012 W. Fairchild, Danville 61832 
Robert Boxer 

64 Old Orchard Rcl., Skokie 60076 
Catherine Dobson 

5842 Stony Island Ave., Chicago 60037 
Bruce G. Fagel 
619 Drexel, Glencoe 60022 


Robert Hamilton 

25 E. Washington St., Chicago 60602 
Mack W. Hollowell 
35 Circle Drive, Charleston 61920 
A. J. Kiessel 

1800 E. Lake Shore Drive, Decatur 62521 
Charles W. Pfister 

5511 N. Harlem Ave., Chicago 60656 
Consultants: 

Robert T. Fox 

2136 Robin Crest Lane, Glenview 60025 


312 


Illinois Medical Journal 


Robert R. Hartman 

I515A W. Walnut, Jacksonville 62650 
J. M. Ingalls 

502 Shaw Ave., Paris 61944 
Jacob E. Reisch 

1129 S. 2nd St., Springfield 62704 
Auxiliary Representative: 

Mrs. Donovan Stiegel (Betty) 

2920 15th Ave., Moline 61265 
Staff: Edward Stuppy 


Responsibilities and Purposes: 

The Council on Public Relations and Membership Ser- 
vices shall plan and execute programs designed to enhance 
the relationship between the media, clergy, general public 
and medical profession. Included shall be health educa- 
tion and socio-economic programs believed to be in the 
best interest of the profession as well as the general public. 
The council shall be responsible for new member orienta- 
tion, exhibits and public service programming. 


COUNCIL ON SOCIAL AND MEDICAL SERVICES 


James C. Reid, Chairman 

712 S. College, Greenfield 62044 
Paul V. Banning 
410 N. 2nd, Marshall 62441 
Jerry L. Beguelin 
Box 197, Irvington 
James S. Berry 

1036 W. Stephenson St., Freeport 61032 
John W. Bowden 

330 Madison, Joliet 60435 
Audley F. Connor 
3233 S. King Dr., Chicago 
Ralston R. Hannas 

1558 W. Fork Dr., Fake Forest 60045 
Kenneth A. Hurst 

157 S. Lincoln, Aurora 60505 
Robert P. Johnson 

108 Maple Grove, Springfield 62707 
Max Klinghoffer 
127 E. Vallette, Elmhurst 60126 
Aaron M. Rosenthal 

1775 Dempster Ave., Park Ridge 60068 
Sheldon S. Waldstein 

222 E. Superior St., Chicago 60611 


Consultant: 

Fred Z. White 

723 N. 2nd St., Chillicothe 61523 
Student Representative: 

Rick Wender 

901 S. Ashland, Chicago 60607 
Physician-in -Training: 

Paul Stromborg 
1741 N. Neva, Chicago 60635 
Staff: Larry Boress 

Committees: 

Committee on Health Care of the 
Poor and Rural Problems 
Committee on Emergency and Disaster Care 
Sub-Committee on Aging 

Responsibilities and Purposes: 

The Council on Social and Medical Services shall ini- 
tiate and implement programs related to health care 
facilities, hospital services, emergency room and disaster 
medical care; maintain liaison with the nursing profes- 
sion and other health-oriented organizations, inclining 
the Illinois Department of Vocational Rehabilitation; 
handle problems related to aging, rural health and health 
care of the poor. 


COMMITTEE ON EMERGENCY AND DISASTER CARE 


Council Members: 

Max Klinghoffer, Chairman 

Ralston R. Hannas, Jr., Vice Chairman 

Non-Council Members: 

David Allan 

14 Peninsula Rd., Lake Villa 60046 
Earl Donelan 

2425 S. Glenwood Ave., Springfield 62704 
Bill B. Smiley 

2115 Hoyt C.t., Decatur 62526 
Consultants: 

Eugene P. Johnson 

P.O. Box 68, Casey 62420 


Allan L. Goslin 

712 N. Bloomington, Streator 61364 
Fredrick E. Weiss 

15643 Lincoln, Harvey 60426 
Staff: Larry S. Boress 

Responsibilities and Purposes : 

This committee is concerned with improving the delivery 
of health care in emergency situations. The committee 
will monitor the effectiveness of emergency medical ser- 
vice programs as they exist throughout the state. It will 
also assist local and state agencies to evaluate new pro- 
grams in emergency and disaster health care. 


SUB-COMMITTEE ON AGING 


Council Members: 

John W. Bowden, Chairman 
Kenneth A. Hurst 
Robert P. Johnson 
Consultants: 

Bertram B. Moss 

Illinois Department of Public Health 
1919 W. Taylor, Chicago 60612 
Larsandrew Dolan 
6016 N. Nina, Chicago 60631 


Stanley R. Palutsis 

360 Fairbank Rd., Riverside 60546 
Mr. Herman Gruber 

AMA, 535 N. Dearborn, Chicago 60610 
Staff: Larry S. Boress 
Responsibilities and Purposes: 

The Committee is to act as a liaison between the medi- 
cal profession and the Illinois Department of Aging. It 
is concerned with the quality of care provided in nursing 
facilities, and the environment surrounding the non-in- 
stitutional elderly. 


for October, 1974 


313 


COMMITTEE ON HEALTH CARE OF THE POOR AND RURAL PROBLEMS 


Council Members: 

Audley F. Connor, Jr., Chairman 
Jerry L. Beguelin 
James S. Berry 

Non-Council Members: 

Helen C. Bonbrest 

1455 N. Sandburg Ter., Chicago 60610 
Raymond R. Clemens 
2100 Glenwood, Joliet 60435 
John L. Froiland 

6101 N. Sheridan Rd., Chicago 60660 
Eugene Gaertner 

1908 St. Charles Rd., Maywood 60153 
Alfred D. Klinger 

5229 S. Woodlawn, Chicago 60616 
Lloyd E. Thompson 
4601 State St., East St. Louis 62205 


Consultants: 

Fred Z. White 

723 N. 2nd St., Chillicothe 61523 
Mr. Gary B. Schwartz 
AMA Health Care of the Poor 
535 N. Dearborn, Chicago 60610 
Mr. Carmello Rodriguez, ASPIRA 
767 N. Milwaukee, Chicago 60622 
Mrs. Lois Kortemeier, Woman’s Auxiliary 
1443 W. Woodside, Freeport 61032 
Staff: Larry S. Boress 
Responsibilities and Purposes : 

The committee's responsibility is to mobilize and utilize 
the resources of the medical profession to achieve available 
and acceptable health care for the poor and for those 
living in rural areas. 


Committees of the 


Board of Trustees 

COMMITTEE ON CONSTITUTION AND BYLAWS 


A. Edward Livingston, Chairman 

326 Fairway Drive, Bloomington 61701 
Herbert Dexheimer 

301 S. Illinois, Belleville 62220 
David S. Fox 

20829 Greenwood Center C.t., Olympia Fields 60461 
George Shropshear 

1525 E. 53rd St., Chicago 60615 
Warren D. Tuttle 
203 N. Vine St., Harrisburg 62946 
Consultants: 

Andrew Brislen 

6060 Drexel Ave., Chicago 60637 
James Fletcher, Esq. 

Burditt & Calkins, 135 So. LaSalle St., Chicago 60603 


Staff: Perry Smithers 

Responsibilities and Purposes: 

The Committee on Constitution & Bylaws shall: 

1) Receive from individual members, county societies, 
committees, the Board of Trustees and the House of 
Delegates, all suggestions and proposals for modification 
of the Constitution & Bylaws; 

2) Prepare for the consideration of the House of Dele- 
gates, all changes in the Constitution & Bylaws; and 

3) Maintain constant surveillance of both documents to 
keep them current, effective and consistent with the poli- 
cies of the House of Delegates. 

The Speaker of the House of Delegates shall be an 
ex-officio member of this committee. 


ETHICAL RELATIONS COMMITTEE 


Joseph Skom, Chairman 

707 Fairbanks Ct., Chicago 60611 
Arthur Goodyear 

142 E. Prairie, Decatur 62523 
Eugene T. Hoban 
6429 North Ave., Oak Park 60302 
Frederick E. Weiss 

15643 Lincoln, Harvey 60426 
Staff: James Slawny 

Responsibilities and Purposes: 

The responsibilities and purposes of this committee 
are outlined in CHAPTER XI. DISCIPLINE, Part 2 
Illinois State Medical Society Procedures. 

Section 1. Illinois State Medical Society Ethical Relations 
Committee. The Board of Trustees shall appoint from 
its members an Ethical Relations Committee to review 
decisions of the component society involving the inter- 
pretation of the Principles of Medical Ethics, violations 
of the Constitution and By-laws of the Illinois State 


Medical Society or its component societies and charges of 
misconduct of members of the Society. 

Section 2. Appeals from Component Society Verdicts. Ap- 
peals received by the Illinois State Medical Society Board 
of Trustees shall be referred to the Ethical Relations 
Committee of the Board of review. (Appeals must be ac- 
companied by a comprehensive stenographic record of 
the proceedings taken before the component county so- 
ciety together with all exhibits submitted in evidence. 
If the component county society fails to provide the 
record on appeal, the Ethical Relations Committee of 
Illinois State Medical Society shall find the accused "not 
guilty.”) The committee shall notify the accused and the 
secretary of the component society by certified mail at 
least thirty days prior to the date set for hearing of 
the appeal. The chairman of the committee shall preside 
over the hearing in accordance with the rules established 
by the Board of Trustees. 

Section 3. Verdict. The Ethical Relations Committee of 
the Board of Trustees shall hear any new and pertinent 


314 


Illinois Medical Journal 


evidence any interested party desires to present, and at 
the conclusion of the trial, the decision of the component 
society shall be affirmed, overruled or sent back to the 
component society for reconsideration. 

Section 4. Notification and right of appeal. The secretary 
of the Society shall notify the defendant and the secre- 


tary of the component society wherein the defendant holds 
membership, of the action of the Board. In the event of 
a decision against the accused he shall have the right to 
appeal the decision to the Judicial Council of the Ameri- 
can Medical Association and the secretary of the State 
Society shall so notify the accused of this right. 


EXECUTIVE 

Joseph L. Bordenave, Chairman 
1665 South St., Geneva 60134 
Fred l ie D. Lake 

1041 Michigan Ave., Evanston 60202 
J. M. Ingalls 

502 Shaw Ave., Paris 61944 
Mather Pfeiffenberger 

State and Wall Streets, Alton 62002 
Allan L. Goslin 

712 N. Bloomington, Streator 61364 
Jacob E. Reisch 

1129 S. 2nd St., Springfield 62704 
William M. Lees 

6518 N. Nokomis, Lincolnwood 60646 
Haroltl A. Sofield 
715 Lake St., Oak Park 60301 
Willard C. Scrivner 

Suite 2, 6600 W. Main, Belleville 62223 
Staff: Roger N. White 


COMMITTEE 

Responsibilities and Purposes: 

The Executive Committee shall consist of the president, 
the president-elect, the first vice president, the chairman 
of the Board, the chairman of the Finance and Medical 
Benevolence Committee, the chairman of the Policy Com- 
mittee, the secretary-treasurer, the trustee-at-large and 
the immediate past chairman of the Board provided he is 
still a Trustee. 

It may be given authority to act by the Board of 
Trustees. 

In matters of routine administration, special plans, 
policy, endorsement or expenditure it shall report to and 
request approval of the Board. It shall receive the re- 
ports of the Finance and Policy Committees and make 
recommendations concerning them to the Board. It shall 
furnish a report of its actions to the Board at each 
meeting. 

(Bylaws, Chapter IX, Part 4, Section 2, Paragraph A.) 


FINANCE COMMITTEE AND MEDICAL BENEVOLENCE 


Mather Pfeiffenberger, - Chairman 
State & Wall Streets, Alton 62002 
Jacob E. Reisch 

1129 South 2nd Street, Springfield 62704 
Robert Fox 

2136 Robin Crest, Glenview 60025 
Ross N. Hutchison 

126 East Ninth St., Gibson City 60936 

Staff: 

Roger N. White 
Richard D. Hengl 

Responsibilities and Purposes: 

The Committee shall consist of the secretary-treasurer 
of the Society and three members of the Board ap- 
pointed by the chairman. It shall develop a budget for 


the fiscal year for approval of the Board through the 
Executive Committee. It shall supervise the financial trans- 
actions of the Society. It shall make recommendations to 
the Board for the control and investment of the funds 
of the Illinois State Medical Society. 

The Finance Committee shall also be responsible for 
the society’s Medical Benevolence Program and shall: 

1. Examine applications for financial assistance and 
determine eligibility. 

2. Keep the names of the beneficiaries confidential and 
known only to the committee. 

3. Determine the allotment for each recipient. 

4. If funds available become inadequate to meet dis- 
bursements, request the Board of Trustees to appropriate 
sufficient funds to support the program until the next 
budget appropriation. 


COMMITTEE ON GOVERNMENTAL HEALTH PROGRAM REIMBURSEMENT 


Philip G. Thomsen, Chairman 
13826 Lincoln, Dolton 60419 
Herbert Dexheimer 

301 S. Illinois, Belleville 62220 
Eugene P. Johnson 

P.O. Box 68, Casey 62420 
William M. Lees 

6518 N. Nokomis, Lincolnwood 60646 
Frederick E. Weiss 

15643 Lincoln, Harvey 60426 


Fred Z. White 

723 N. 2nd St., Chillicothe 61523 
Consultant: Jacob E. Reisch 
Staff: Joseph J. Lotharius 

Responsibilities and Purposes: 

The responsibilities of the Committee on Governmental 
Health Program Reimbursement will be to consider all 
problems of physician reimbursement by the government 
health programs— Medicare, Medicaid, MEDICHEK and 
CHAMPUS. 


for October, 197-f 


315 


POLICY COMMITTEE 


Allan L. Goslin, Chairman 

712 N. Bloomington, Streator 61364 

Warren D. Tuttle 

203 N. Vine St., Harrisburg 62946 

David S. Fox 

20829 Greenwood Center Ct., Olympia Fields 60461 
Staff: Perry Smithers 

PUBLICATIONS 

Jacob E. Reisch, Chairman 

1129 S. Second St., Springfield 62704 
Warren W. Young 
3450 Haweswoocl Dr., Crete 60417 
Eugene T. Hoban 
6429 North Ave., Oak Park 60302 
James A. McDonald 

13 S. Second St., Geneva 60134 
A. Edward Livingston 

326 Fairway, Dr., Bloomington 61761 
Staff: Richard A. Ott 

Responsibilities and Purposes: 

The Publications Committee shall be composed of five 
members of the Board of Trustees, and shall be respon- 
sible for the production of the Illinois Medical Journal 

ADVISORY COMMITTEE 

J. M. Ingalls, Chairman 

502 Shaw Avenue, Paris 61944 
Eredric D. Lake 

1041 Michigan Avenue, Evanston 60202 
Joseph I,. Bordenave 

1665 South Street, Genera 60134 
Staff: Roger N. White 


Responsibilities and Purposes: 

The Policy Committee shall consist of three members 
of the Board appointed by the chairman. It shall con- 
tinually review past and current proceedings of fhe House 
of Delegates to determine the established policies of the 
Illinois State Medical Society. It shall make recommen- 
dations for future policy by Board resolution to the House 
of Delegates. 

COMMITTEE 

and other Society publications. 

It shall recommend to the Board of Trustees all poli- 
cies governing the editorial, business and production as- 
pects of the Journal. It shall supervise the editor in the 
selection and preparation of all copy, and it shall estab- 
lish standards for the editorial content. 

It shall establish advertising policies, rates and stan- 
dards, and shall review all new accounts prior to accept- 
ance. and shall approve reprint and circulation policies. 

It shall conduct a periodic review of the printer’s con- 
tract and solicit bids as indicated. It shall establish the 
format, cover, type faces and general layout of the Journal. 

The committee may establish such editorial consulta- 
tion groups as necessary to assist in development of 
clinical articles and shall authorize all regular and spe 
cial features. 

WOMAN’S AUXILIARY 

Responsibilities and Purposes: 

The committee shall consist of the president-elect as 
chairman, the president, the chairman of the Board. The 
committee shall provide advice and assistance to the presi- 
dent of the Woman’s Auxiliary in her program for the 
year, and shall assist her in interpreting the activities 
of the state medical society to the auxiliary members. 


Direct Reporting Committees 

All Board Committees previously noted consist of members of the Board of Trustees. As 
such they function within the activities of the Board. 

Direct Reporting Committees are groups deemed necessary by the Board of Trustees and are 
created by the Board to meet specific challenges. These committees may function with, and 
under, a council, or may report directly to the Board of Trustees. 

While other select committees will be formed from time to time, at the time of publication 
the following groups had been established. 


ANNUAL MEETING JOINT MANAGEMENT COMMITTEE 


Harold A. Sofield, Chairman 
715 Lake St., Oak Park 60301 
Joseph L. Bordenave 

1665 South St., Geneva 60134 
C. Larkin Flanagan 

505 N. Lake Shore Dr., Chicago 60611 
Vincent C. Freda 

4600 N. Ravenwood Ave., Chicago 60640 
James A. McDonald 

13 S. 2nd St., Geneva 60134 
Jacob E. Reisch 

1129 S. Second St., Springfield 62704 


Andrew Thomson 

1725 W. Harrison St., Chicago 60612 
Fred Z. White 

723 N. Second St., Chillicothe 61523 

Staff: Perry Smithers 

Responsibilities and Purposes: 

The committee, consisting of equal numbers of repre- 
sentatives of the Chicago Medical Society and ISMS mem- 
bers outside of Cook County is responsible for the overall 
management of the Midwest Clinical Conference, which 


316 


Illinois Medical Journal 


is co-sponsored annually by the two organizations, in 
cooperation with various medical specialty groups. This 
committee establishes broad policy for the convention, 
including the setting of dates and place for the meeting, 


decides on the general format of the program, deli- 
neates the areas of responsibility for the major co- 
sponsoring organizations, and oversees the budget for the 
conference. 


COMMITTEE ON COMPREHENSIVE HEALTH PLANNING 


John J. Ring, Chairman 
511 E. Hawley, Mundelein 60060 
A. G. Baxter 

34 N. Water, Batavia 60510 
|ames B. Borgerson 

119 S. Vine St., Mt. Pulaski 62548 
Charles |. Jannings 

301 N.W, 11th. Fail-held 62837 
James R. Kennedy 
401 N. Wail, Kankakee 60901 
Ervin E. Nichols 

1 E. Wacker Dr., Suite 2700, Chicago 60601 
Joseph R. O’Donnell 
444 Park, Glen Ellyn 60137 


Byron Ruskin 

Memorial Hospital, Mattoon 61938 
Irwin A. Smith 

1141 Church, Northbrook 60062 
Staff: Joseph J. Lotharius 

Responsibilities and Purposes: 

The ISMS CHI’ Committee was re-established to keep 
physicians abreast of all developments in the area of 
health planning and to encourage a leadership role for 
physicians in this important field. The Committee main- 
tains ongoing liaison with the State CHP Agency and the 
areawide "b” agencies. 


COMMITTEE ON DRUGS AND THERAPEUTICS 


Arthur R. Marks, Chairman 

101 E. Center St., Fairfield 62837 
Richard L. Landau 
950 E. 59th St.. Chicago 60637 
Andrew Krajec 

108 W. South St., West Salem 62476 
Richard H. Suhs 

1409 Stevenson Drive, Springfield <52703 
William T. Gogan 
7623 W. 63rd St., Summit 60501 
Charles Salesman 
Box 426. Paris 61944 
Vincent A. Costanzo, Jr. 

7531 S. Stony Island, Chicago 60649 
Thomas William Lester 

2017 W. 107th St., Chicago 60643 


Consul! an r: 

Louis Gdalman, R.Ph. 

5418 S. East View Park, Chicago 60615 

Staff: Mrs. Pat LIznanski 

Responsibilities and Purposes: 

The Committee shall meet periodically to refine the 
drug list contained in the Drug Manual. It shall work 
with the Illinois Department of Public Aid in an effort 
to keep the Drug Manual current and effective. When sug- 
gestions and comments from the members are submitted 
to the committee, it shall review them and present them 
to the Department of Public Aid when necessary. The 
committee shall also consider other drug matters affecting 
the policy of the medical society. 


COMMITTEE ON HOSPITAL RELATIONS 


il Dr., Libertvville 60048 


Matthew B. Eisele, Chairman 
4501 N. Park Dr.. Belleville 62223 
Raphael M. \delman 
1202 Oak Trail 
Mfred Clementi 

1320 Haddington Ct.. Palatine 60067 
Charles G. Farnum, Jr. 

221 N.E. Glen Oak, Peoria 61603 
Charles J. Weigel 

7579 Lake St., River Forest 60305 


Consultant 
David S. Fox 

20829 Greenwood, Olympia Fields 60461 
Staff: James R. Slawny 

Responsibilities and Purposes: 

To develop informational materials and programs which 
will assist physicians in drafting and revising hospital 
medical staff bylaws. 


COMMITTEE ON INSURANCE 


Philip 1). Boren. Chairman 
S. Plum St., Carmi 62821 
Martin Compton 

3003 E. Oakland Ave., Bloomington 61701 
Lawrence Knox 

1200 N. East St„ Olney 62450 
Theodore LeBoy 

917 Norwood Dr., Melrose Park 60160 


Charles W. Schlagater 

2950 Payne Ave., Evanston 60201 

Consultants: 

David S. Fox 

826 E. 61st St., Chicago 60637 
A. Everett Joslyn 

557 Keystone Ave., River Forest 60305 


for October , 1974 


317 


Jacob E. Reisch 

1129 S. Second St., Springfield 62704 
Staff: Perry L. Smithers 

Responsibilities and Purposes: 

The Committee on Insurance will review society-spon- 
sored insurance programs, which are currently the Tax 


Qualified Retirement Program (Keogh Plan), Retirement 
Investment Program, Group Disability Program, Business 
Overhead Expense Insurance, Group Major Medical Pro- 
gram, Hospital Benefit Program, Group Life Insurance and 
Professional Liability Insurance Program. The committee 
will study these plans, make suggestions for changes, addi- 
tions and cancellation of policies, and investigate other 
insurance programs that may benefit society members. 


PHYSICIAN COMPETENCE COMMITTEE 


Thomas W. Stach, Chairman 
Williams M. Lees, Vice-Chairman 

6518 N. Nokomis Ave., Lincolnwood 60646 
Willard C. Scrivner 

Suite #2. 6600 W. Main St., Belleville 62223 
Fredric D. Lake 

1041 Michigan Avenue, Evanston 60202 


J. M. Ingalls 
502 Shaw, Paris 61944 

George T. Wilkins 

3165 Myrtle, Granite City 62040 

Staff: Philip G. Thomsen II 


COMMITTEE ON QUACKERY AND UNAUTHORIZED PRACTICE OF MEDICINE 


William M. Lees, Chairman 

6518 N. Nokomis, Lincolnwood 60646 

Charles Daisey 

308 College, Greenville 62246 
Robert Prentice 

2248 Warsen Rd., Springfield 62704 

Phillip Haggerty 

1409 Stevenson, Springfield 62703 

Richard Treanor 

1430 N. State Rd., Arlington Heights 60004 
Staff: Richard A. Ott 


Responsibilities and Purposes: 

To function as an educational and monitoring group: 
to maintain awareness of cultist activities and initiate 
action to blunt these; to monitor education and registra- 
tion activities to eliminate cultist frauds upon the public; 
to provide expert testimony as necessary regarding the 
difference between scientific medicine and cultists. Cultist 
groups initially of concern to the committee include 
chiropractic, naturopathy, napropathy, Scientology. In ad- 
dition, the committee shall be on guard against the un- 
authorized practice of medicine by licensed or registered 
health care professionals who exceed the scope of practice 
allowed by their licensing acts, and shall coordinate this 
appropriately with other ISMS committees. 


Other Appointments and Representatives 

REPRESENTATIVES TO STUDENT LOAN FUND BOARD 


Donald Stehr, Chairman 

102 E. Market, Havana 62644 
Jack Gibbs 

175 S. Main St., Canton 61520 
Charles Salesman 

1 Laurel Lane, Paris 61944 
Consultant: 

Jacob E. Reisch 

1129 S. 2nd St., Springfield 62704 


Staff: Perry L. Smithers 


Purpose: 

ISMS representatives on the Student Loan Fund Board 
are responsible to the Board of Trustees in matters re- 
lated to administration of the Student Loan Program 
operated jointly with the Illinois Agricultural Association. 


INA-ISMS JOINT PRACTICE COMMITTEE 


Bernard H. Adelson 
595 Lincoln, Glencoe 60022 

Fred /.. White 

723 N. 2nd St., Chillicothe 61523 


Robert M. Reardon 

1008 N. Main St., Bloomington 61701 
J. M. Ingalls 

502 Shaw, Paris 61944 
Staff: Philip G. Thomsen II 


OTHER REPRESENTATIVES 


Swanberg Foundation, Quincy 
Arkell M. Vaughn 

9012 S. Leavitt, Chicago 60620 

Long Term Care Advisory Council to IDPH 
Robert P. Johnson 

108 Maple Grove, Springfield 62707 


Midwest Recional Library Association 
H. Close Hesse] tine 
5807 S. Dorchester, Chicago 60637 
Liaison to III. Soc. of the Amer. Assoc, 
of Med. Assts. 

Carl E. Clark 

225 Edward St., Sycamore 60178 


318 


Illinois Medical Journal 


Illinois Council of Home Health Agencies 
Francis Bihss 

4601 State, E. St. Louis 62205 
Chicago Alliance for VD Awareness 
Edward Piszczek 

6410 N. Leona, Chicago 60646 
Bar Associations Interprofessional Code 
Donal O’Sullivan 
411 W. Dickens, Chicago 60614 
Marshall Segal 

650 Wrightwood, Chicago 60614 
Council on Efficiency of Health Care 
Eugene P. Johnson 

P.O. Box 68, Casey 62420 
James Laidlaw 

Christie Clinic, Champaign 61820 
Joseph R. O’Donnell 

444 Park, Glen Ellyn 60137 
Fred A. Tworoger 
4753 Broadway, Chicago 60640 
Drug Abuse Council of Illinois 
George Shropshear 

1525 E. 53rd St., Chicago 60615 
Joseph Skom 

707 N. Fairbanks, Chicago 60611 
Pediatric Coordinating Council 
Daniel Pachman 

1212 N. Lake Shore, Chicago 60605 
Joint Committee on School Health 
Richard E. Dukes 
Carle Clinic, Urbana 61801 
Willard W. Fullerton 

101 N. Market, Sparta 62286 
III. Interagency Coun. on Smoking and Disease 
Peter G. Gilbert 

116 Sophia St., West Chicago 60185 


The Illinois Committee For Perinatal Health/ 
Perinatal Morality 
Robert R. Hartman 

1515A W. Walnut, Jacksonville 62650 
William R. Larsen 

13707 W. Jackson, Woodstock 60098 

ISMS/IPS Peer Review Consulting Committee 
Alex Spadoni, Chairman 
2301 Glenwood, Joliet 60435 
Howard D. Kurland 
636 Church St., Evanston 60201 
S. Dale Loomis 

700 N. Michigan, Chicago 60611 
Marshall Falk 

4700 N. Clarendon, Chicago 60640 
Donovan G. Wright 

135 S. Kenilworth, Elmhurst 60126 

U.S. Pharmacopeia 
Joseph Skom 

707 N. Fairbanks, Chicago 60611 

MD Committee on Optometry 
Warren Kreft 

940 Lee St., DesPlaines 60016 
Samuel Schall 

30 N. Michigan, Chicago 60602 

School Health Physicals Task Force— CHP 
Julius Kowalski 

436 Park Ave. East, Princeton 61356 
Charles J. Jannings, Alternate 
R.R. #4, Fairfield 62837 

Statewide Cooperation Organizations of the 
Commission on Children 
Daniel Pachman 

1212 N. Lake Shore, Chicago 60605 


ISMS House of Delegates 
Committees 

SELECT COMMITTEE 


J. M. Ingalls, Chairman 
502 Shaw, Paris 61944 
C. Larkin Flanagan 

720 N. Michigan, Chicago 60611 
David S. Fox 

20829 Greenwood Center Ct., Olympia Fields 60461 
Jack L. Gibbs 

175 S. Main,